What are the responsibilities and job description for the Clinical Auditor-IBR position at MultiPlan dba Claritev?
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we striveto bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders - internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!
COMPENSATION
The salary range for this position is $75-80k annually. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
2. Documents audit results and updates systems accordingly. Assist management in the daily operations and processes within the department.
3. Identify opportunities for recovery and avoidance. Researches opportunities to better control overpayments and presents ideas to management.
4. Drive successful coding operations through the application of learned, certified knowledge in addition to continuous professional development and ongoing coding research.
5. Provide general support to clinical team members, serving as a resource and subject matter expert (SME).
6. Monitors turnaround times for multiple applications and provides suggestions for process efficiencies.
7. Uses independent decision making skills to review claims after business hours to meet deadlines.
8. Apply national coding standards and regulations to claims billed.
9. Research and review individual claims, claim trends or detailed itemized bills, operative notes and other documentation as needed.
10. Monitor, research, and summarize trends, coding practices, and regulatory changes.
11. Apply clinical judgment and high level of expertise along with analytic skills in review of the most challenging and difficult cases; including conducting additional research as needed.
12. Communicates clinical, coding and reimbursement findings to co-workers and management in a clear, organized manner.
13. Partner with management to drive department goals and objectives
14. Collaborate, coordinate, and communicate across disciplines and departments.
15. Ensure compliance with HIPAA regulations and requirements.
16. Demonstrate Company's Core Competencies and values held within.
17. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
18. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled