Senior Executive

Location

Chennai | India

Job description

Overview

1. Responsible for reviewing/auditing claims and identify the findings based on the billing and check on compliance with CMS guidelines.

Qualifications:

1. Bsc Nursing, Indian RN with minimum 2 years of clinical experience.

Experience:

1. Previous experience in clinical audits is preferred.
2. In depth clinical knowledge and skill set to identify various trends in clinical review.
3. Understanding of ICD-10 coding and application of knowledge in PDPM auditing.
4. Expertise knowledge in various clinical conditions, treatments, and diagnostic tests, preferably for Nursing home patients.
5. Knowledge in Minimum data set (MDS) and CMS Medicare polices, preferable.
6. Understanding need for various rehabilitation services required based on clinical conditions and identify the services were apt and rendered to Nursing home patients timely.

Communication:

1. Strong written (documentation) and good oral communication skills

Working Hours:

1. 40 hours per week as Full time employee
2. Shift time: 08:00AM TO 05:00PM IST
3. Weekends Off

Telecommuter/Internet requirements, if applicable:

1. High Speed internet connection at home, must be broadband
2. Must understand and adhere with telecommuter policy

• Required attention to detail for clinical data and specific requirements for Medicare patients.
• Excellent communication skills including writing finding/incomplete letters, business email communication with clients.
• Able to correlate recent hospital admitting diagnosis and reason for SNF admission, and able to conclude the review based on the clinical presentation, care rendered, rehabilitation and Nursing services were utilized.
• Ensure adherence of Client SOW, audit review criteria.
• Ensure reviews are performed per Client expectations
• Ensure integrity and honesty while performing reviews
  1. Ex : Medical records should be completely reviewed prior to concluding the audit review outcome
• Ensure adhere to Compliance while performing reviews
• Ensure to identify and provide appropriate reports on anomalies, issue scenarios while reviewing audits.
• Provide all the info required for Client communication
• Provide all the info to answer all the clinical queries as requested by Client within 24 hours of time frame.
• Provide all the required info to Client /lead on clinical, production and quality within TAT.
• Provider all the required reports to maintain good Client communication and ensure Client satisfaction
• Available for Client meeting, client calls as required on program performance.
• Ensure Client focus is the most important priority
• Ensure productivity and quality numbers committed to Client are adhered to and achieved.
• Ensure every report to Client is sent as per TAT and possible prior to TAT.
• Ensure delivery of each and every aspect of the audit process like Selections, inventory, audit, QC, appeals, uploads and reporting is within TAT as applicable
• Ensure inventory is worked as per Client expectations
• Ensure Client productivity and quality targets for the team are adhered to, and work towards exceeding the same.
• Ensure productivity and quality targets for the team are adhered to
• Ensure QC % is delivered based on the agreed QC % with Client

Job tags

Salary