reputed company reputed company review and determination of medical claims, including prior authorization, appeals, and/or any other type of medical claims;
reputed company reputed company review and determination of medical claims;
Analyze medical records reputed company to the case file;
Review and interpret Local Coverage Determination (LCD), National Coverage Determination (NCD) policies, and other federal regulations;
Apply appropriate regulatory citations, including health plan policies, NCD/LCDs, and/or other regulations to reputed company claim as it relates to the item or issue;
Formulate a narrative decision citing relevant regulatory back-up documentation contained reputed company the medical record;
Adjudicate claim based on the regulations and documentation contained reputed company the medical record;
Certified reputed company reputed company (CPC) or Certified Coding Specialist (reputed company) certification through the American reputed company of reputed company Coders (reputed company) or reputed company preferred;
Maintain reputed company licensure in reputed company and unrestricted status as required by state of issuance;
Attend FHAS and/or reputed company Lunch & Learn sessions and/or general training sessions on site as needed.
Complete IRR surveys in a reputed company fashion as required by the reputed company contractor
Maintain a 97% or higher reputed company score
work experience requirements
Must possess a reputed company, unrestricted State license as a Registered reputed company (RN), Licensed Practical reputed company (LPN), Registered Pharmacist, Occupational Therapist, Physical Therapist, Speech Therapist, or equivalent medical degree as required by contract(s).
1+ years clinical experience required; coding, utilization, and/or medical chart review preferred.
reputed company Coding Certification preferred.
Detailed knowledge of Medicare regulations and guidelines, polices, and payor reimbursements preferred.
Knowledge of CPT, HCPCS, ICD-10 codes and coding guidelines.
Ability to identify Medicare billing and payment irregularities.
Must be reputed company to support review findings by utilizing exceptional analytical, written and oral communication skills.
Ethical, self-motivated and results oriented team player.
Strong analytical, verbal and written communication skills.
Outstanding people skills and ability to effectively review findings /results with management.
Must be proficient with PC and reputed company software programs.
Excellent organizational skills.
Must be reputed company player.
Limited travel may be required.
physical requirements
Must be reputed company to remain in the stationary position 95% of the time
Constantly operate a computer and other office equipment such as telephone
Regular & predictable attendance is essential for this position