Conducts routine audits and investigations into claims to ensure validity and compliance with regulatory standards. Compiles detailed findings, interviews relevant stakeholders, and provides recommendations to management for claim resolution.
Qlarant
4 Remote Job Openings at Qlarant
Performs medical record and claims reviews to identify potential fraud, waste, and abuse within Medicare and Medicaid programs. Conducts desk reviews, field audits, and provides case summaries to support investigative processes.
The Nurse Specialist II performs medical record and claims reviews to identify potential fraud, waste, and abuse within Medicare and Medicaid programs. They also conduct field audits, provide case summaries for investigators, and participate in legal proceedings as necessary.
The specialist facilitates evaluations to assess the quality of support and services provided to individuals with intellectual developmental disabilities. They also collaborate with service providers to implement improvements and ensure adherence to health, safety, and regulatory standards.
