The Claims Recovery Analyst I is responsible for identifying, validating, and recovering healthcare claim overpayments through Trend's Payment Accuracy Services. This role involves analyzing medical and pharmacy claims data while collaborating with providers to ensure accurate claim adjustments and resolutions.
The Medical Director provides physician-level clinical oversight, strategic guidance, and escalation support for payment integrity services including DRG validation and clinical appeals. They act as a clinical authority and strategic advisor to leadership while managing payer-facing clinical discussions and peer-to-peer reviews.
The Nurse Coding Auditor validates the accuracy of CPT, HCPCS, and revenue codes on inpatient and outpatient facility claims. They perform hospital bill audits and itemized bill reviews to ensure services are appropriately documented and billed according to CMS guidelines.
