The analyst is responsible for verifying provider and patient information to audit claims and request necessary medical documentation. They must maintain production standards and ensure the strict confidentiality of PHI and PII.
CERIS
13 Remote Job Openings at CERIS
The supervisor oversees the itemization review process, managing nurse workloads, queues, and client appeals. They are responsible for maintaining monthly metrics, ensuring HIPAA compliance, and fostering a collaborative team environment.
The coordinator manages the distribution of claims to Quality Control and Itemization Review Nurses to ensure a balanced workflow. They are also responsible for maintaining departmental spreadsheets, updating SharePoint, and assisting with new hire documentation.
The coordinator manages PPI department mailboxes and assigns appeals to team members based on established workflows. They are responsible for maintaining accurate appeal trackers and preparing metrics reports to monitor performance and compliance.
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 analyst is responsible for conducting pre- and post-pay claim audits based on client policies, industry standards, and CMS guidelines. This includes reviewing itemized bills and DRGs while providing professional written communication for audits and appeals.
The role involves reverse coding medical bills to ensure accuracy and making claim-related recommendations to stakeholders. Responsibilities include processing claims based on state regulations and maintaining HIPAA compliance.
The Director of Implementations provides strategic leadership for client programs, overseeing the entire implementation lifecycle from prospect presentation to operational transition. They are responsible for managing cross-functional teams, enforcing implementation standards, and driving continuous process improvement across the organization.
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.
The Certified Coder reverses codes previously coded medical bills to verify coding accuracy and is responsible for making claim-related recommendations and communicating the status of the claim to involved parties. This role involves processing claims based on state rules, determining claim validity using proprietary programs, and adhering to client and carrier guidelines.
The supervisor manages the daily activities of the payment integrity team, focusing on quality assurance and provider appeals, ensuring timely and accurate processing of requests and audits. Responsibilities include assisting the team with complex questions, conducting reviews based on clinical knowledge and payer policy, and managing employee guidance, coaching, and performance appraisals.
The Implementation Manager is responsible for product enhancement and development while managing the implementation process from prospect presentation through conclusion for new and existing clients. This role facilitates the transition of client programs to field operations and account management personnel for ongoing service.
