Overview Position Overview: We are seeking a Senior Payment Integrity Specialist to play a key role in building... and implementing proprietary healthcare edits that drive cost savings and accuracy in claims processing. The successful candidate...
Specialist and other members of the health care team. Promotes high standards of practice and holds staff and self accountable... types. Supports revenue integrity and compliance through established policies and procedures. Supports denial management...
and respond to discovery requests, and trial preparation. The Claims and Litigation Specialist Risk Manager is a primary point... liability standards of care as well as regulatory standards inclusive of Joint Commission, Medicare Conditions of Participation...
related to Medicare and Medicaid, laws regarding confidentiality, compliance, release of information, probate and lien... records and all other pertinent patient information, and applies clinical and regulatory knowledge, screening criteria...
extensive knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG... of clinical documentation to ensure that clinical coding is accurate for proper reimbursement and that coding compliance...
audits as assigned to ensure charge and claim accuracy and compliance. RI Nurse Auditor is responsible for reviewing... to date with the various Centers of Medicare and Medicaid (CMS) and commercial/managed care insurance companies claim filing...
such as computer assisted coding and encoders as a means to ensure compliant billing of Carle claims. HIM Certified Coder... is responsible for understanding and applying all regulatory coding guidelines, such as National and Local Coverage Determinations...