The Customer Service Advocate provides support to members and providers by answering inquiries regarding benefits, eligibility, and claims in a call center environment. They are responsible for documenting calls, resolving adjudication issues, and ensuring high-quality service through one-call resolution.
The HEDIS Abstractor is responsible for collecting and abstracting medical record data into HEDIS software to support quality improvement initiatives. They coordinate with provider offices to verify information, schedule reviews, and maintain accurate documentation logs.
Design and verify radiation treatment plans and dose calculations, contour normal and dose-limiting structures, and support imaging, simulation, localization, and treatment delivery. Collaborate with radiation therapists and other clinical staff, document patient treatment information, teach dosimetry practices, and participate in continuing education and quality improvement.
The specialist performs thorough medical record reviews to identify and assign accurate ICD-CM and ICD-10 PCS codes for inpatient facility coding. They also provide clinical documentation improvement support and ensure compliance with official coding guidelines and hospital policies.
The Prior Authorization Rep II is responsible for verifying insurance eligibility, calculating patient estimates, and securing prior authorizations for complex medical services. They act as a liaison between payers, medical staff, and providers to resolve authorization issues and ensure financial security for the organization.
This position is responsible for abstracting, coding, and interpreting outpatient clinic and provider services for billing purposes. The role also involves serving as a resource for coding staff, resolving complex billing issues, and educating personnel on regulatory guidelines.
The Nurse Specialist improves the quality and completeness of clinical documentation by educating physicians and staff on documentation standards. They facilitate modifications to medical records to ensure accurate reflection of patient status, clinical treatment, and appropriate reimbursement.
