Audites medical charges to ensure appropriate reimbursement according to state fee schedules and guidelines.Determines relatedness, causality and appropriateness of treatment based on the compensable injury.Identifies potential fraudulent claims and assists adjusters with SIU (Special Investigation Unit) referrals.Handles telephone and written customer service inquiries and complaints.Ensure that vendors fee agreements are applied to the appropriate claims accurately.

Responsible for master surgery schedule for Hospital, Ambulatory Care Services and in office procedures.Conduct preoperative visits and clearances for surgical procedures.Audit medical records with any CPT and ICD-10 codes for discrepancies.Submit predeterminations, obtain prior authorizations and complete appeals for denials.EPIC Superuser and assist training new employees during GO-LIVE implementation.Problem-solving skills in providing safe patient care for upcoming procedures.Educated patients and families with postoperative instructions for upcoming surgeries.Gathered, obtained and collected data in preparation for upcoming surgeries, including medication instructions.Sending medications to pharmacy and refilling medications as needed.

Confirm master schedule is consistent with budgeted census and operational standards.Maintained care center electronic scheduling system on daily basis.Determined care center open positions and corresponding schedules.Oversaw the daily schedule as relates to call offs and adherence to attendance policy and procedures.Called and verified references for new employees as Hiring Team Captain.Responsible for directing, coordinating and interviewing during the recruitment process.Facilitate employee orientation and new hire onboarding process.