ACT!, Illustrator, Highrise, and Insightly.
April 25, 2023
Supports claims editing escalated provider disputes/appeals and provides guidance across all areas of the company with regards to claims editing and proper coding, billing, and payment.
December 23, 2022
Acts as liaison with other departments when additional clarification is needed about claims payment policy disputes.
January 08, 2023
Leads implementation efforts with respect to new or modified edits and works with other departments to ensure proper integration with existing systems and edits.
January 30, 2023
Monitors and reports on performance of current claims editing packages.
February 02, 2023
Works closely with claims editing vendors on maintaining and updating edits as changes in the regulatory, legislative, or industry accepted payment policy requires.
March 21, 2023
Collaborates with other departments to improve compliance with coding conventions and clinical practice guidelines.
April 13, 2023
Reviews medical records to ensure coding is consistent with the services billed and compares against the clinical coding guidelines in order to decide if a claim adjustment is necessary.
April 14, 2023
Communicate with providers to exchange info and to gain feedback regarding appropriate claims submission practices.
May 19, 2023