Address
Form of workJob Description
Responsibilities:
Compensation:
The pay rate range above is the base hourly pay range that Aditi Consulting reasonably expects to pay someone for this position (compensation may vary outside of this range depending on a number of factors, including but not limited to, a candidate’s qualifications, skills, competencies, experience, location and end client requirements).
Benefits and Ancillaries:
Medical, dental, vision, PTO benefits and ancillaries may be available for eligible Aditi Consulting employees and vary based on the plan options selected by the employee.
- Reviews for medical necessity, coding accuracy, medical policy compliance and contract compliance.
- Ensures diagnosis matches ICD10 codes.
- Triages and prioritizes cases to meet required turn-around times.
- Prepares and presents cases electronically to the Medical Director (MD) for approvals or denials and medical necessity determination.
- Communicate determinations to providers in compliance with state, federal and accreditation requirements.
- Identifies potential quality of care issues, service or treatment delays and intervenes or as clinically appropriate.
- Provides referrals to Case Management, Disease Management, Appeals and Grievance and Quality Departments as
- necessary.
- Assists in the development and implementation of a proactive approach to improve and standardize overall retro claims
- review for clinical perspectives.
- Demonstrates BSC leadership behaviors.
- Works to achieve operational targets with significant impact on the departmental results.
- Work is performed with limited oversight.
Compensation:
The pay rate range above is the base hourly pay range that Aditi Consulting reasonably expects to pay someone for this position (compensation may vary outside of this range depending on a number of factors, including but not limited to, a candidate’s qualifications, skills, competencies, experience, location and end client requirements).
Benefits and Ancillaries:
Medical, dental, vision, PTO benefits and ancillaries may be available for eligible Aditi Consulting employees and vary based on the plan options selected by the employee.
