The Appeals Coordinator II manages and resolves provider appeals, grievances, and complaints while ensuring compliance with regulatory requirements. They also prepare case files for external reviews and collaborate with internal stakeholders to determine case outcomes.
The coder is responsible for performing outpatient coding reviews to identify inaccurate billing, documentation gaps, and potential overpayments. They must document audit findings clearly and defensibly while adhering to payer policies and coding guidelines.
The DRG Reviewer analyzes inpatient claims to validate ICD-10-CM/PCS codes and ensure accurate DRG assignment for billing. They collaborate with physician reviewers and maintain high productivity and accuracy standards in claim reviews.
The Data Scientist will collaborate with cross-functional teams to design, build, and operationalize predictive models to solve business challenges. They are responsible for gathering and cleaning data, performing exploratory analysis, and communicating insights to stakeholders using visualization tools.
The Physician Reviewer will perform DRG clinical validation reviews to ensure accurate diagnoses and compliance with evidence-based guidelines. They will also produce clinical summaries and collaborate with internal teams to support documentation accuracy and healthcare quality.
Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record. Maintain and manage case reviews with a high emphasis on quality in a fast-paced environment.
