TASKS AND RESPONSIBILITIES:

Performs research, reviews and assessments of broad compliance issues and specific internal audit engagements and per government and or non-government payer requests. Ensure all invoices and or related medical record documentation are submitted accurately and timely per requirements.       Requests from customer, necessary patient medical record documentation as needed to ensure and or support billing is in accordance with requirements. Appeals claims payment determinations as needed and within payer indicated filing requirements to best support reimbursement for services performed. Responds to verbal and written customer inquiries within a reasonable timeframe. Researches accounts and document follow up appropriately. Resolves discrepancies and prepares adjustments and or refunds for approval as necessary. Meets or Exceeds Standards for Quality. Utilizes with increasing proficiency and effectiveness, proprietary reports, tools and systems required to perform duties. Working proficiency with all systems and applications. With moderate guidance and direction, timely executes assigned standard reports and updates according to schedule. Documents relevant facts, information and conclusions drawn to support the work performed so other reviewers may validate claim. Assists with information gathering and analysis for internal risk management and audit processes. Address problems as they occur. Keep supervisor advised of area of compliance concerns which may lead to untimely or inaccurate completion of invoice or claim submission. Perform other tasks as assigned to support the goals of the organization.