Analyzes and Audits Claims; Integrates medical chart coding principles, clinical guidelines and objectivity in performance of medical audit activities.
Effectively Utilizes Audit Tools; Utilizes Cotiviti proprietary auditing systems with a high level of proficiency to make audit determinations and generate audit letters.
Meets or Exceeds Standards/Guidelines for Productivity and Accuracy/Quality.
Cotiviti is a company that focuses on Coding & Clinical Chart Validation for Inpatient audits. They offer a competitive benefits package to address a wide range of personal and family needs.
Assist clinicians with gathering medical information for patients.
Report any medical concerns monthly for patients.
Completion of PCM as assigned and as needed.
MTC Care is the nation’s leading telemedicine provider of behavioral health care to skilled nursing, assisted living and independent living facilities. Their clinical team includes trained psychiatry and psychology providers, and they are committed to delivering top-notch behavioral health services.
Monitors work volume and work distribution to maintain optimal efficiency.
Reviews and reconciles reports and assigned work queues, troubleshooting problem accounts.
Researches coding questions and provides coding training as needed.
Children’s Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children, providing a wide range of care and support. As the region's only independent healthcare system dedicated to children, they offer rewarding career opportunities and encourage employees to be their best.
Review incoming referral orders to assess patient’s needs based on diagnosis, insurance coverage or lack thereof, and previous treatments.
Verify patient information including demographics, insurance coverage and financial status; confirm patient eligibility for health care coverage and clarify any managed care arrangements.
Contact the patient prior to service to inform them of their estimate and collect any pre-payments at that time.
OHSU is Oregon's only public academic health center, caring for patients and leading groundbreaking research. As Portland's largest employer, they offer opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington.
Assess referred concurrent denials and determine next steps for resolution.
Review medical record documentation to support denial management strategies.
Advocate for patients to ensure coverage and reimbursement.
They are currently looking for a Utilization Management Coordinator. By enhancing operational efficiencies and implementing educational initiatives, this role significantly impacts the financial and quality outcomes of healthcare delivery.