Job title: Senior Executive
Company: EXL IT service management
Job description: JOB TITLE: SENIOR EXCECUTIVE – CLINICAL REVIEWER JOB DESCRIPTION * The clinical Auditor performs reviews, analyzes, and codes documentation from medical records that determines payments. This position performs highly technical and specialized func
JOB TITLE: SENIOR EXCECUTIVE – CLINICAL REVIEWER JOB DESCRIPTION The clinical Auditor performs reviews, analyzes, and codes documentation from medical records that determines payments. This position performs highly technical and specialized functions, and the primary function of this position is to perform a thorough review of patient encounters to assess for completeness and accuracy of provider documentation and billed claim. This function also ensures compliance with established standard medical and coding guidelines, third party reimbursement policies, regulations and accreditation guidelines. Perform analysis of data and understand the reasons for denial reasons, use appropriate codes to be used in documentation of the reasons for denials. ESSENTIAL CRITERIA: NCLEX Certification compulsory US active RN license Broad clinical experience (must be Western Medicine, would prefer nursing experience in the US) 3-5 years of auditing experience Strong communication skills both written and verbal Computer literate (MS, Word, Excel, Access) Strong personal and professional ethics Bachelor’s Degree in Nursing preferred Resource Utilization Groups experience is preferred. Some ICD-9/ICD-10/CPT coding experience preferred (does not need to be a CPC) ESSENTIAL RESPONSIBILITIES: Follow every aspect of SOP without fail Complete received Audits with Quality Follow project related protocols and instructions Update all the logs like productivity, Clarification log, and any other logs applicable on a daily basis. Check with Manager /TL in case of clarifications All emails from Manager should be answered promptly without fail. Upon completion of medical record audit, compiles detailed findings and prepares client reports, when needed. Communicate proper volume to support invoicing. Provides feedback and process improvement recommendations to appropriate leadership team and participates in workgroups/committee meetings and process improvement solutions as required. Participates in and/or leads inter-departmental process improvement initiatives. Maintains professional license and certifications and attends training conferences/webinars as necessary to keep abreast of latest trends in the field of expertise. Identifies compliance risks and financial opportunities based on chart reviews. Prepares reports and executive summaries as required by management regarding audit results, process improvement recommendations, and systemic billing errors. Adheres to established productivity and quality standards, participates in departmental performance improvement activities and work level. Communicates and works with all internal and external customers. Performs other duties as assigned.
Expected salary:
Location: Chennai, Tamil Nadu
Job date: Fri, 10 Jun 2022 22:30:04 GMT
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