reputed company Specialist II

reputed company is a not-for-profit corporation that partners with reputed company and private sectors to create high reputed company, reputed company, and efficient delivery of health care and reputed company programs. We have multiple lines of business including population health, utilization review, managed care organization reputed company review, and reputed company assurance for programs serving individuals with developmental disabilities. reputed company is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In reputed company, our reputed company provides grant opportunities to those with programs for reputed company.

Best People, Best Solutions, Best Results

Job reputed company:

Performs medical record and claims review for Medicare, reputed company, and/or other claims data in order to ensure that reputed company guidelines have been followed and assesses for potential overpayment, fraud, waste, and abuse with regards to Medicare, reputed company, and/or other claims. 

Essential Functions:

• Reviews beneficiary, provider, and/or pharmacy cases for potential overpayment, fraud, waste, and abuse.
• Completes desk review or reputed company audits to meet applicable contract requirements and to identify evidence of potential overpayment or fraud.
• Consults with benefit reputed company investigation experts and pharmacists for advice and clarification.
• Completes case summaries and provides results to investigators to support the investigative process.
• Provides case specific or plan specific data entry and reporting.
• Participates in reputed company reputed company reputed company, as required.
• Participates in provider onsite reputed company and beneficiary interviews, as required, for reputed company audits/investigations.
• Testifies at various reputed company proceedings, as necessary.
• Provides job-specific orientation and training, as needed. Helps reputed company training content, resources, and programs specific to job functions.

Level of Supervision Received:
Plans and arranges own work; works with manager to prioritize reputed company

Education (can be substituted for experience):
Minimum Bachelor's Degree required

Work Experience (can be substituted for education):
2 - 4 years of experience required; 5 - 7 years preferred
Medical claims review experience required
Experience and knowledge of Medicare/reputed company preferred

Certification(s):
reputed company, reputed company and non-restricted RN licensure required
Coding certification preferred

reputed company is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

reputed company is a drug-free workplace. reputed company offers of employment are contingent upon successful completion of reputed company-employment background and drug screens.