on fraudulent claims. How you will make an impact: Claim reviews for appropriate coding, data mining, entity review, law... enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims...
record. Participate in utilization review process: data collection, trend review, and resolution actions. Participate in... and all required documentation. Maintain knowledge of regulations/standards, company policies/procedures, and department operations. Review/analyze...