In this role, the selected candidate will manage clinical activities, including patient assessments, care plan development, service level determination, on-site field visits, and the implementation /coordination/maintenance/evaluation of care plans.
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$45K to $75K -Apopka, FL
In this role, you will be responsible to
Review all Medicare and other episodic payers clinical records at the local level to assure appropriate documentation for reimbursement. This review includes verification of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines.
In this role, you will have the demonstrated ability to work at all levels of the organization to identify and drive systemic root cause and corrective action utilizing quantitative, qualitative analytical capabilities to communicate and influence others in a concise, data driven manner.
In this role, you will manage third-party fraud investigation activities through subordinate supervisors who oversee fraud investigation and resolution activities, including identification, prevention, and resolution of fraudulent activity including review of new accounts, unusual customer transactions, check and deposit fraud, card fraud, signature verification, loan applications and online fraud.
In this role, you will oversee the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure, certification, and accreditation results.