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VE Claims Auditor
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$22.31 - $25.66 a year
Full-time
- POSITION SUMMARY Promotes and maintains the quality and accuracy rate of claims payment based on analysis of Virtual Examiner (VE reports).
- Conducts thorough research of pre-and post disbursement processes for fee for service claims.
- Respond to provider disputes resulting from scrubbing claims data through Virtual Examiner software.
- COMPLIANCE WITH REGULATIONS Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D and Special Needs Plan (SNP).
- RESPONSIBILITIES Run Virtual Examiner (VE) reports and perform data analysis to identify unbundling, incorrect coding, inappropriate billing, and possible fraud for services provided by vendors.
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