Availability for immediate consult. Thorough understanding of human resources principles and practices including employment law, AA, ADA and EEO. Subject matter expertise in Title IX, Title VII and ADA laws and principles.
Must have in-depth knowledge of medical terminology, human anatomy/physiology, pharmacology, and pathology. Must have expert and up-to-date knowledge of industry Official Coding and Reporting Guidelines.
Reviewing medical files and provides recommendations for utilization review. Identifying, critiquing, and utilizing current criteria and resources. Returning cases in a timely manner with clear concise and complete rationales and documented criteria. Required Skills:
Valid driver's license and reliable transportation. RN or Bachelor's Degree in Health or Human Services or related discipline. At least three (3) years' experience working with members with a behavioral health condition and/or intellectual/developmental disabilities.
Proficiency in Oracle Java or Microsoft . NET. Passion for building quality systems. Experience in shipping complex software systems. Familiarity with automated testing frameworks. Experience with open source tools and resources.
Extensive knowledge of outpatient coding, coding guidelines, official coding resources and disease processes. Must be able to satisfy the eligibility requirements for obtaining a government issued security clearance.
Serving as an expert resource in reviewing all medical records in support of consistent documentation for all payer types. Collaborating in the development of programs which provide alignment with education for internal customers to support clinical documentation guidelines.