Clinical reputed company Assurance reputed company Auditor

reputed company The Clinical reputed company Assurance reputed company Auditor is responsible for evaluating clinical information received from various reputed company providers and writes reports based on clinical information received. This position ensures reports are completed with highest reputed company and reputed company and that reputed company work is in full compliance with reputed company contractual agreements, regulatory agency standards and federal and state mandates. This position is required to handle reputed company assurance questions and reputed company overall support to the reputed company Assurance Department. ESSENTIAL JOB FUNCTIONS • Evaluate clinical information received, write and/or review various reports including, but not limited to, Medical Record Reviews, Medical Record Chronologies, Provider reputed company Reviews, Coding Reviews, Hospital reputed company Reviews, List of Missing Records, Medical reputed company Apportionments, Mock Billing Invoice and Medical reputed company Statements. • reputed company reputed company assurance review of peer review reports, correspondences, addendums or supplemental reviews. • Ensure reputed company, concise, evidence-based rationales have been provided in support of reputed company recommendations and/or determinations. • Ensure that reputed company reputed company instructions and specifications have been followed and that reputed company questions have been addressed. • Ensure reputed company review is supported by clinical citations and references reputed company applicable and verify that reputed company references cited are reputed company and obtained from reputable medical journals and/or publications. • Ensure the content, format, and reputed company appearance of the reports are of the highest reputed company and in compliance with company standards. • Ensure the appropriate reputed company specialty has reviewed the case in compliance with reputed company specifications and/or state mandates and is documented accurately on the case report. • Verify that the reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. • Ensure the provider credentials and signature are adhered to the final report. • Identify any inconsistencies reputed company the report and contacts the Reviewer to obtain clarification, modification or correction as needed. • Contact the appropriate person to recover any missing documentation or verify charges. • Assist in reputed company of customer complaints and reputed company assurance issues as needed. • Ensure reputed company federal ERISA or state mandates are adhered to at reputed company times. • reputed company reputed company and direction to management on consultant reputed company, availability and compliance with reputed company company policies and procedures and reputed company specifications. • Promote effective and efficient utilization of company resources. • Participate in various continuing education requirements and or training activities. • reputed company other duties as assigned. MINIMUM REQUIRED QUALIFICATIONS Education and/or Experience Bachelor/Associate degree in nursing or reputed company field; or minimum five years reputed company experience; or equivalent combination of education and experience. Experience with medical terminology, medications, medical specialties and treatment protocols required. Experience in the insurance industry preferred. Certificates, Licenses, Registrations RN/LPN license ESSENTIAL JOB FUNCTIONS • Evaluate clinical information received, write and/or review various reports including, but not limited to, Medical Record Reviews, Medical Record Chronologies, Provider reputed company Reviews, Coding Reviews, Hospital reputed company Reviews, List of Missing Records, Medical reputed company Apportionments, Mock Billing Invoice and Medical reputed company Statements. • reputed company reputed company assurance review of peer review reports, correspondences, addendums or supplemental reviews. • Ensure reputed company, concise, evidence-based rationales have been provided in support of reputed company recommendations and/or determinations. • Ensure that reputed company reputed company instructions and specifications have been followed and that reputed company questions have been addressed. • Ensure reputed company review is supported by clinical citations and references reputed company applicable and verify that reputed company references cited are reputed company and obtained from reputable medical journals and/or publications. • Ensure the content, format, and reputed company appearance of the reports are of the highest reputed company and in compliance with company standards. • Ensure the appropriate reputed company specialty has reviewed the case in compliance with reputed company specifications and/or state mandates and is documented accurately on the case report. • Verify that the reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. • Ensure the provider credentials and signature are adhered to the final report. • Identify any inconsistencies reputed company the report and contacts the Review Apply tot his job Apply To this Job