The Itemization Review Manager oversees daily file flow and workflow for the Medical Review department while managing and mentoring nursing staff. They are responsible for performance evaluations, quality assurance of review results, and handling human resources matters for direct reports.
The Payment Integrity Analyst reviews and completes pre- and post-pay claim audits based on client policies, industry standards, and CMS guidelines. They utilize clinical judgment to interpret policies and ensure accurate healthcare payment processing.
The Provider Management Analyst verifies provider information and audits claims by reviewing medical records and itemized bills. They are responsible for maintaining production standards and ensuring the confidentiality of patient health information.
The Senior Manager, Clinical Audit leads and coordinates teams of auditors to ensure accurate medical bill reviews and compliance with organizational goals. This role involves managing performance metrics, overseeing HR duties for staff, and maintaining adherence to service level agreements.
The Director leads the strategic development and operational oversight of DRG clinical validation and audit initiatives to ensure payment integrity. They manage teams of auditors while collaborating across departments to drive quality outcomes, regulatory compliance, and business growth.
The VP of Strategic Business Development will lead efforts to strengthen client relationships and serve as the primary point of contact for business development and retention. This role drives strategic alignment across stakeholders and supports the sales team as a subject matter expert to foster growth.
The Payment Integrity Analyst reviews and audits pre and post-pay claims to ensure compliance with client policies, industry standards, and CMS guidelines. The role involves utilizing clinical judgment to interpret documentation and collaborating with internal teams to complete appeals and audits.
The Itemization Review Nurse analyzes medical facility charges on UBIB forms to ensure billing accuracy. They are responsible for documenting conclusions and maintaining compliance with HIPAA regulations.
The analyst is responsible for reviewing and monitoring repricing audit data to ensure accuracy, compliance, and efficiency across multiple platforms. They will identify quality issues, implement QA policies, and collaborate with stakeholders to align quality objectives.
Review and analyze provider inquiries and appeals via various communication channels in accordance with regulatory and client guidelines. Ensure all appeals are accurately set up and initiated in a timely manner to support efficient processing.
