Empower AI

Medical Reviewer

• Perform comprehensive medical record and claims review to make payment determinations based on Insurance coverage, coding, and utilization of services and practice guidelines for Medicare A, Outpatient Facilities and Services.
• Performs first and second level of Medical Review in determination of claims payment review
• Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles
• Utilize electronic health information imaging and input medical review decisions by electronic database module.
• Utilize internet and intranet sources for policy verification.
• Utilize Microsoft Office suite and other software templates as associated source input for claims review.
• Make clinical judgment decisions based on clinical experience when applicable.
• Responsible for review of Medicare Part A claims.
• Meeting quality and production standards.
• Ensuring departmental compliance with quality managements system and ISO requirements.
• Completes other projects or duties as assigned by the Lead Medical Review Specialist

Medical Reviewer III

Engineer

• DIGIT is seeking a Senior Mobile Device Management Engineer to support the design, implementation, monitoring, management, change management, software upgrades, problem/incident resolution, and root cause analysis of GSA’s Mobile Devices.
• Perform Level 3 / Tier 3 Mobile Device Management (MDM) Engineering and Administration of applicable mobile devices to include all phases of the life cycle.
• Update all iOS devices in the environment.
• Work with Maas360 (IBM) to comply with audit recommendations for the GSA Mobile environment.
• Assisting with refresh efforts of mobile devices.
• Develop analytical and computational techniques and methodology for problem solution.
• Prepare and present written and oral reports.

Senior Mobile Device Management Engineer

Customer Support

• Contact and communicate with providers to obtain required medical record documentation in an expeditious manner
• Respond to telephone inquiries promptly, professionally, and efficiently to provide resolution
• Analyze provider questions to determine best use of resources to resolve the situation
• Serve as liaison between the providers and the various departments or team members in response to inquiries
• Professionally respond to all written inquiries (letter, e-fax, email)
• Process rejected records that do not meet initial inspection criteria and contacts providers to resubmit legible copies
• Assist providers in identifying what is being requested and answers their inquiries
• Process and verifies received records through provider communication indicating when invalid documentation is replaced or ready for assignment
• Maintain competency and attends required education and training programs
• Comply with all departmental protocols, policies and procedures
• Perform other duties as assigned by Call Center Manager/Medical Records Supervisor

Medical Reviewer III

Senior Mobile Device Management Engineer

Customer Service Representative