- Evaluate inpatient claims to ensure they are accurate and compliant with healthcare regulations and payer guidelines.
- Assess the medical necessity of inpatient services provided and ensure that the documentation supports the claims.
- Work closely with clinical staff, billing teams, and insurance companies to resolve discrepancies and facilitate the claims process.
- Assist in developing and updating policies related to inpatient claims processing and compliance.
- Participate in audits and reviews to improve the accuracy of claims and reduce denials.
- Evaluate inpatient claims to ensure they are accurate and compliant with healthcare regulations and payer guidelines.
- Assess the medical necessity of inpatient services provided and ensure that the documentation supports the claims.
- Work closely with clinical staff, billing teams, and insurance companies to resolve discrepancies and facilitate the claims process.
- Assist in developing and updating policies related to inpatient claims processing and compliance.
- Provide training to clinical and administrative staff on documentation standards and coding requirements.
- Participate in audits and reviews to improve the accuracy of claims and reduce denials.
Physicians only, BSC in medicine & surgery3 years clinical experience not including internship yearExperience in health insurance companies or TPA companiesExperience in inpatient claim adjudication and processingExperience in coding (ICD10 AM, CPT and ACHI) is a plus