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About the Role:
- Conduct pre- and post-payment medical reviews.
- Assess medical necessity, appropriateness, and reimbursement eligibility.
- Document decisions per regulatory requirements.
Key Responsibilities:
- Provide rationales for service approvals or denials.
- Educate teams on review processes and coding.
- Support quality control activities.
Broadway Ventures
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), they empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth.