TEKsystems
Minneapolis, MN, USA
Job Description
This client provides medical review services to their clients. Their clients are typically state or federal agencies, TPAs, healthcare insurance insurers, and some self-funded employers that want to outsource this function to the client. They provide advisory medical reviews on claims such as workers compensation, group health and disability claims. They also do some IME - Independent medical examinations.
JOB DUTIES:
Making payment determinations. For example, parties have gone back and forth and haven't settled on a proper claim payout based on the CPT code. This person would say this is the right party, here is why, etc. They will be deciding payment determinations for claims.
They must have their CPC or CPC-A, but they will not be doing any coding in this role.
Will be working on/reviewing a lot of emergency services, ambulance services, air ambulance and non air ambulance so a lot of emergency providers. If they have knowledge/experience...