Essential Duties and Responsibilities: - Review requests for services including admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements. - Issue approvals, denials or recommendations based on contract
Essential Duties and Responsibilities: - Facilitate the development of cross-line-of-business solutions by combining knowledge of business capabilities, value streams, and business processes. Consult with technical subject matter experts to develop technical solutions and advise on options,
Essential Duties and Responsibilities: - Audit medical records to ensure compliance with the Medicare Advantage Risk Adjustment standards including abstraction and assignment of appropriate codes based on clinical data. - Enter coded data into a system
Essential Duties and Responsibilities: - Facilitate the development of cross-line-of-business solutions by combining knowledge of business capabilities, value streams, and business processes. Consult with technical subject matter experts to develop technical solutions and advise on options,