Greenlife Healthcare Staffing

• Conduct utilization reviews up to and including the appeal level. This includes chart screen, completing electronic worksheets, entering the required information, and making level one denial decisions when necessary. • Conduct quality and clinical study data collection reviews. This includes a chart review, complete detailed electronic data worksheets. • Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures. Will provide technical assistance and conduct/participate in staff huddles. • Participate in collaborative training specific to clinical study objectives. • Other activities as may be deemed necessary.

• Conduct reviews up to and including the appeal level. This includes chart screen, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations. • Act as a resource for the administrative and clinical staff in training, problem-solving, and clarifying determinations. Will provide technical assistance and conduct/participate in staff huddles. • Participate in collaborative training • Other activities as may be deemed necessary

• Conduct utilization reviews up to and including the appeal level, including chart screens, completing electronic worksheets, and making level one denial decisions when necessary. • Perform quality and clinical study data collection reviews, which involve detailed chart reviews and completing electronic data worksheets. • Act as a resource for administrative staff by providing training, technical assistance, problem-solving, and clarifying procedures. • Participate in collaborative training specific to clinical study objectives and staff huddles. • Perform other duties as assigned to support the team and organizational goals.

• Review clinical documentation for accuracy and completeness • Support coders by providing clinical insight and clarification • Assist with audit reviews and quality improvement • Query providers for missing or unclear clinical details • Stay updated on coding and clinical documentation regulations

• Perform detailed retrospective and prospective coding audits • Prepare audit findings and summary reports • Identify compliance risks and recommend corrective actions • Provide education to coders and clinical staff

• Oversee daily administrative operations • Supervise billing and coding staff • Ensure accurate claims submission and follow-up • Implement office policies and productivity standards • Monitor compliance with federal and payer requirements • Manage staff schedules, reporting, and performance

• Review claims for accuracy and compliance. • Assist with appeals and disputes. • Interpret payer policies and communicate updates. • Identify reimbursement trends and risks. • Support the revenue cycle and compliance team.

• Review documentation for completeness • Support coding team with clinical clarification • Assist in audits and quality improvement • Follow up with providers for needed information

• Conduct utilization reviews up to and including the appeal level. This includes chart screen, completing electronic worksheets, entering the required information, and making level one denial decisions when necessary. • Conduct quality and clinical study data collection reviews. • Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures. • Participate in collaborative training specific to clinical study objectives. • You will be using InterQual criteria to review the medical records of inpatient high cost hospital stays for admission and acute level of care. • You'll also review and validate itemized bills and need to have the ability to write up responses to send to the hospital. • Other activities as may be deemed necessary

• Act as point-of-contact for appeal/dispute adjudication programs. • Liaise with healthcare plans, providers, patients, and clients to coordinate requests, correspondence, and submission of case documentation, as necessary. • Monitor appeal/dispute status and communication received on client portals. • Conduct initial eligibility reviews and recommend a course of action to internal team and department management. • Track and assign cases using commercial off-the-shelf and custom software applications. • Review and provide case documentation to assigned billers/coders, nurses, physicians and clinicians internal teams, and key stakeholders to facilitate clinical and coding reviews. • Monitor and measure key performance indicators, including, but not limited to, timeliness, adherence to quality and accuracy standards, and deadlines for contract deliverables. • Identify barriers and roadblocks in work processes, recommend solutions to solve problems, and execute approved solutions. • Routinely present case/project status in huddles and scrums while using an agile, iterative approach to implementation and data presentation. • Schedule regular team status meetings and record decisions (e.g., assigned tasks and next steps). • Prepare billing invoices at the conclusion of cases, submit them to the Finance department, and liaise with accounting to track and trend payments. • Mentor and train new staff, at all levels, on process steps and case progression. • Other activities as may be deemed necessary