07/05 Sawina Sharma
HR Manager at Future Plannerz

Views:332 Applications:21 Rec. Actions:Recruiter Actions:0

Clinical Investigator - Hospital - BHMS/BUMS/BAMS/BPT/MPT (0-2 yrs)

Noida Job Code: 14420

- This process works on identifying discrepancies between medical records and billed services for complex and high value claims by identifying Up-coding, UN bundling, Duplication, and Misrepresentation of services.

- They approve/deny claims & Identify provider aberrant behavior patterns.

- The associates prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/ diagnosis codes,

- CMC guideline along with referring to client specific guidelines and member policies

Job Responsibilities :

- Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies

- Adherence to state and federal compliance policies and contract compliance

- Assist the prospective team with special projects and reporting

- Any graduate in Bhms,Bums,Bams,Bpt,Mpt,Bsc nurse with 6 months exp,

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