HR Manager at Future Plannerz
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Clinical Investigator - Hospital - BHMS/BUMS/BAMS/BPT/MPT (0-2 yrs)
- 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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