Full Time
UMass Memorial Health
Hybrid (Worcester, MA, USA)
Job Description
Major Responsibilities:
Plans, develops, and implements the review. Determines scope of review, such as number of patient services, sample sizes, mix of physician/facility services, etc.
Reviews professional and hospital claim form documents in conjunction with patient medical record to ensure appropriate coding and clinical documentation. Also reviews reimbursement documents to validate appropriate reimbursement, identify overpayments and/or missed opportunities.
Prepares presentation of findings and recommends corrective actions to ensure compliance with applicable governmental regulations and organizational policies and procedures.
Presents to physicians, clinicians, and/or administrative staff to educate regarding coding, billing, and documentation requirements to meet government and third-party payer requirements.
Reviews and responds to external audit requests surrounding supervision, coding, billing, and documentation...