Work from Office
Full Time
This process works on identifying discrepancies between medical records and billed services for complex and high value claims by identifying Up-coding, Unbundling, Duplication, and Misrepresentation of services. They approve/deny claims & Identify provider aberrant behavior patterns. The associates prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/ diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies.
-Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies
-Adherence to state and federal compliance policies and contract compliance
-Assist the prospective team with special projects and reporting
-Medical degree Graduate or Postgraduate - BPT/MPT/BHMS/BAMS/BUMS only
- BSC-Nursing /BDS/MDS only eligible if they have 1 year of corporate experience.
-Attention to detail & Quality focused.
-Good comprehension skills
- Experience Range 6 months to 3 years
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