POSITION SUMMARY:
This position is responsible for maintaining claims data quality through ongoing quality review and assessment of medical records to ensure appropriate procedures were received. Perform concurrent audits on accuracy of DRG, OPPS, PPS and MPFS payment logic rules. Document findings on reports and identified trends to further evaluate appropriate payment logic is built within the system as well as review post-payment claims that have been identified. Work with the team to help document ways to improve processes for identified risks.
QUALIFICATIONS:
Education, skills and experience:
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