POSITION SUMMARY/RESPONSIBILITIES
Functions under the direct supervision of the Special Investigations Unit (SIU) Manager. Performs at the advanced skill level of a Coding Specialist. Is adept at data collection and statistical report generation. Demonstrates individual judgement, initiates work improvement methods. Will conduct administrative investigations related to fraud and abuse. Will conduct research related to eligibility, claims payment, benefits, prior authorization/referrals and contract review. Responsible for conducting and reviewing audits to assess the quality of coding and documentation to ensure compliance with federal and state laws and regulations. Responsible for researching and compiling documentation that may be reported to external regulatory and law enforcement agencies. Research and audit for accurate provider and facility payments. Identifies overpayments to provider. Assists provider, employee and contractors with the Community First Health Plan's anti-fraud program. Conducts routine education programs for staff and physicians to communicate findings from investigations, coding and documentation audits.
EDUCATION AND EXPERIENCE
High school diploma or its equivalent is required. Five years of experience with ICD-9-CM/DRG assignment, chart auditing, and CPT4 code assignment is required or only two years of experience if candidate has successfully completed a Certified Coding Program or Health Information Management Program. Must be knowledgeable of ICD-10. Must be knowledgeable of Microsoft Office products.
...the University committed to providing an exemplary NCAA Division I Athletics Program that creates an environment where student-athletes have high-impact learnin Soccer Coach, Assistant Coach, Soccer, Assistant, Head Coach, Coach University of North Carolina Asheville
...Farm Equipment Operator (6296) Location: Callaway, Nebraska JobNumber: 6296 Full-time farming position open near Arnold, NE. Center pivot irrigation. All Pivots are ran by Valley Base Station Remote Service. Excellent facilities and modern to new John Deere equipment...
...Neurology - Physician at UPMC Magee-Women's Hospital - UPMC summary: This fellowship opportunity at UPMC Magee offers neurologists specialized training in clinical neuroimmunology and multiple sclerosis, focusing on comprehensive care for patients with MS and related...
...The START Center for Cancer Research (START) is the worlds largest early phase site network... ...are hiring a motivated In Vivo Research Assistant I. Under direct supervision of the... ...: Paid time off, flexible schedule, and remote work choices provided Plus, we work...
...Job Description Assistant Dairy Farm Manager Facilities, Equipment, and Cropping Operations Kutztown, PA Corner View... ...research farm for our sister company, AMS Galaxy USA. We combine deep agricultural roots with a passion for innovation. As a small, close-knit...