Clinical Content Analyst
Research to support payment accuracy based on Correct Coding Guidelines.Manage the integrity of the Medicaid Payment Policy Library and integrated claims management and ensure that it is accurate and up-to-date.Help the clients develop a comprehensive, rule driven & defensive payment policy that allows the client to pay claims accurately using research skills, coding expertise and industry knowledge of constantly updating healthcare payment policy library due to changing federal & state regulatory & clinical guidelinesResolution of research requests created by clients with respect to claim denials & providing insights based on clinical and coding review of claims to assure that accurate coding guidelines were used for basis of payment.Maintaining new rules(algorithms) based on Centre for Medicare and Medicaid Services Guidelines (CMS), State medicaid Guidelines.