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 lead analyst is responsible for monitoring and analyzing repricing audit data to ensure accuracy, compliance, and operational efficiency. They will also develop quality policies, provide training, and collaborate with stakeholders to meet organizational quality objectives.
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 Closing Team Lead monitors closing processes, maintains reports, and oversees the training of new Closing Analysts. They also provide quality control, handle escalations, and assist with special projects as needed.
The Hospital Bill Audit Nurse reviews medical records to verify the accuracy of hospital charges against industry guidelines and payor contracts. The role involves independent scheduling, onsite travel to provider locations, and documenting audit findings to identify discrepancies.
The Team Lead provides support to the Itemization Review Supervisor and coordinates with internal departments to ensure processing accuracy. They are responsible for analyzing billing data, documenting conclusions, and maintaining quality assurance standards for the team.
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 Clinical Review Supervisor oversees daily activities of DRG Clinical Auditors and ensures the integrity of diagnosis and procedure code verification. They are responsible for maintaining accuracy rates, meeting quotas, and providing clinical support for medical review determinations.
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.
The Clinical Auditor performs DRG validation reviews of medical records to ensure billing accuracy and compliance with regulatory standards. They also assist the quality control team and medical director with appeals and rebuttals while identifying potential reimbursement savings.
