Community Health Group
Chula Vista, CA, USA
POSITION SUMMARY Audits medical records to ensure compliance with coding procedures and standards, based on CHG's protocols, regulatory requirements (CMS, DHCS, DMHC), and American Medical Association (AMA). Reviews and provides processing recommendations on routes from Claims Disputes and Claims Department. Collaborates with CMO to review medical records to validate claim determinations. Identifies training needs for Claims and Provider Services department. Ensures compliance with coding, fee-schedule, and system changes. Works closely with department leadership to improve efficiencies, make recommendations that will support the departmental goals and provide resources and education to Claims and Provider Services Departments. COMPLIANCE WITH REGULATIONS: Works closely with all departments necessary to ensure that processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable...
