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Clinical Consultant - Clinical Dispute Resolution and Coding


Capitol Bridge LLC


Location

Arlington, TX | United States


Job description

Job Requisition: Clinical Consultant - Clinical Dispute Resolution and Coding

Job Summary: The Clinical Consultant will play a pivotal role in supporting clinical review projects and managing the clinical coding associated with those contracts. The ideal candidate will bring extensive clinical expertise, a deep understanding of independent medical review processes, and a proven history in clinical coding.

Key Responsibilities:

  1. Clinical Review Support:
    • Participate in clinical review projects, working closely with cross-functional teams to analyze and resolve clinical disputes efficiently.
    • Participate and conduct state hearings as needed in support of assigned projects.
    • Collaborate with legal and compliance teams to ensure adherence to regulations and contractual obligations during dispute resolution processes.
  2. Clinical Coding:
    • Oversee and manage the clinical coding processes related to projects, ensuring accuracy and compliance with industry standards.
    • Provide guidance to coding teams and contribute to continuous improvement initiatives in clinical coding practices.
  3. Documentation and Reporting:
    • Maintain comprehensive documentation of clinical review resolution activities, ensuring a clear and auditable trail of actions taken.
    • Generate regular reports on clinical coding accuracy, clinical review outcomes, and key performance indicators for senior management.
  4. Collaboration and Communication:
    • Collaborate effectively with internal stakeholders, including legal, compliance, finance, and operational teams.
    • Communicate with external parties, including clients and regulatory bodies, to address clinical coding and dispute resolution matters.

Qualifications:


Job tags

Full time


Salary

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