Review members medical records from primary and specialist care providers to verify and ensure appropriate and accurate claims diagnosis data in compliance with CMS and State-specific guidelines. Make necessary adjustments to claims with complex coding issues. Discuss coding issues with providers. Configure claims payment system to identify and correctly pay common diagnosis combinations. Essential Functions: -Review medical records to ensure appropriateness and accuracy of billed ...
HEALTHeCAREERS Network - 2 years ago
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