Provider Reimbursement Validation Specialist Jobs

The Provider Reimbursement Validation Specialist reviews appropriateness of CPT-4/ICD-10 coding and determines if care provided corresponds to the charges submitted. Determines the extent to which patients' insurance covers their treatments. Being a Provider Reimbursement Validation Specialist may assist in identifying fraudulent non-plan billing practices and assists the legal department with litigation preparation. Ensures compliance with Federal and State regulations and company policies that govern Medicare and state payment systems. In addition, Provider Reimbursement Validation Specialis ... t may require a bachelor's degree. Typically reports to a supervisor or manager. Typically requires Certified Professional Coder (CPC) from AAPC or AHIMA. Being a Provider Reimbursement Validation Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. Working as a Provider Reimbursement Validation Specialist typically requires 2 to 4 years of related experience. More
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