\n
\n
POSITION SUMMARY/RESPONSIBILITIES
\nFunctions under the direct supervision of the Special Investigations Unit (SIU) Manager. Performs at the advanced skill level of a Coding Specialist. Is adept at data collection and statistical report generation. Demonstrates individual judgement, initiates work improvement methods. Will conduct administrative investigations related to fraud and abuse. Will conduct research related to eligibility, claims payment, benefits, prior authorization/referrals and contract review. Responsible for conducting and reviewing audits to assess the quality of coding and documentation to ensure compliance with federal and state laws and regulations. Responsible for researching and compiling documentation that may be reported to external regulatory and law enforcement agencies. Research and audit for accurate provider and facility payments. Identifies overpayments to provider. Assists provider, employee and contractors with the Community First Health Plan's anti-fraud program. Conducts routine education programs for staff and physicians to communicate findings from investigations, coding and documentation audits.
EDUCATION AND EXPERIENCE
\nHigh school diploma or its equivalent is required. Five years of experience with ICD-9-CM/DRG assignment, chart auditing, and CPT4 code assignment is required or only two years of experience if candidate has successfully completed a Certified Coding Program or Health Information Management Program. Must be knowledgeable of ICD-10. Must be knowledgeable of Microsoft Office products.
...BluSky Restoration wants to hire YOU as a full-time Restoration Technician. This position has a starting pay of up to $25 an hour, depending on experience! Benefits Include: ~ Medical, Dental, and Vision Insurance ~401K Plan with guaranteed match ~ Paid Time...
Job Description Norfolk Southern (NS) conductors are responsible for the safe and efficient movement of freight trains. A conductor's duties include coupling railcars to build trains, delivering railcars to local customers, and transporting trains hundreds of miles. Responsibilities...
A leading technology integrator in Washington, DC is seeking a mid-senior level professional to lead UiPath engagements. The ideal candidate will have over 10 years of experience in object-oriented programming and strong expertise in UiPath development. Responsibilities...
...Freight Broker - VL Job Category: Sales Requisition Number: FREIG001823 Posted: May 21, 2025 Full-Time On-site Transportation, Logistics Sales - VB2 1985 International Way Hebron, KY 41048, USA Job Details Description Verst Logistics National...
...New Job! Addictions (MAT), Partial and IOP work in Philadelphia. Addictions day program. Psychiatrist must have MAT with PA license. Part Time to Full Time work. Competitive hourly rates or salary at full time with full benefits. If you have interest contact Jay...