TASKS AND RESPONSIBILITIES:

• Performs research, reviews and assessments of broad compliance issues and specific internal audit engagements and per government and or non-government payer requests.
• Ensure all invoices and or related medical record documentation are submitted accurately and timely per requirements.
• Requests from customer, necessary patient medical record documentation as needed to ensure and or support billing is in accordance with requirements.
• Appeals claims payment determinations as needed and within payer indicated filing requirements to best support reimbursement for services performed.
• Responds to verbal and written customer inquiries within a reasonable timeframe.
• Researches accounts and document follow up appropriately.
• Resolves discrepancies and prepares adjustments and or refunds for approval as necessary.
• Meets or Exceeds Standards for Quality.
• Utilizes with increasing proficiency and effectiveness, proprietary reports, tools and systems required to perform duties. Working proficiency with all systems and applications.
• With moderate guidance and direction, timely executes assigned standard reports and updates according to schedule.
• Documents relevant facts, information and conclusions drawn to support the work performed so other reviewers may validate claim.
• Assists with information gathering and analysis for internal risk management and audit processes.
• Address problems as they occur. Keep supervisor advised of area of compliance concerns which may lead to untimely or inaccurate completion of invoice or claim submission.
• Perform other tasks as assigned to support the goals of the organization.

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