Concurrently reviews medical records and assists physicians in removing the barriers between clinical and coding languages to allow more specific and complete documentation. Through interaction with the physicians and other members of the health care team, facilitates improvement in quality, completeness and accuracy of the medical record documentation to support severity of illness, expected risk of mortality and complexity of care of the patient. Will also be responsibility for maintaining active status for all providers by successfully completing initial and subsequent credentialing required for commercial payers, Medicare and Medicaid.

• Customizes and implements the concurrent review process.
• Educates members of the patient care team regarding documentation guidelines and regulatory requirements.
• Supports timely, accurate and complete documentation of clinical information.
• Formulates/assists with physician compliant query processes.
• Concurrently, enters working clinical diagnoses into the 3M Encoder to determine DRG status, including MC and MCCs.
• Participates in Utilization Review Committee and informs hospital committees of documentation changes and/or requirements developed by CMS and other regulatory agencies.
• Works with Revenue Cycle team to review charts <15 % reimbursement.
• Works closely with other Quality Department members to help with other functions of Quality Department on an as needed basis.

• Facilitates the application from new and existing providers through all stages to enroll or re-validate the providers with commercial and/or Government payers, as well as facilities.
• Compiling of confidential data and communication with providers, payers and medical staff via email, phone, Teams and mail.
• Responsible for updating practitioner information in internal software and with external payers.
• Maintain the provider’s online profiles, and conduct verification of all data, ensuring accuracy and timely entry
• Develops and maintains excellent working relationship with provider practices and health plan contacts regarding provider enrollment statuses.
• Investigates and resolves enrollment issues with health plans that are impending the accuracy of billing and reimbursement.
• Share essential updates with providers and the internal team in monthly summary reports or as often as necessary.