Audits claims to identify examiner and system errors. Research and resolve.
Maintains a solid working knowledge of Health plan and provider contracts, division of responsibility (DOFR), and CPT/ICD9 coding.
Audits daily professional and facility claims
Flags claims for examiner errors.
Researches system configuration against contracts and flag claims for system configuration errors.
Calculates drug claims
Audits and tests system configuration changes or new client implementations
Reviews daily audit reports and takes appropriate actions.
Performs retrospective audits identifying overpayments, underpayments and system configuration issues.
Identifies any inappropriate provider billing issues.
Maintain proper accounting records, back up and reports