Audits Provider Contract Module to ensure compliance with policies and procedures. Ensures that protocols are followed with regard to provider contract, contract reimbursement, established guidelines.
Essential Functions & Responsibilities
Conduct audits of the entry made into the Provider Admin Module to ensure the accuracy in entry and to ensure adherence to the department’s contract loading guidelines.
Review and audit all contract uploads performed by IT to ensure the upload was performed accurately.
Review and audit provider entries by the staff as a result of a claim edit.
Review and audit all contract entries by the staff as the result of a request from Network Management, Credentialing and/or Utilization Management.
Review and audit custom fee schedules created and updated by the provider admin team
Required Education and Experience
Minimum 3 years experience in a medical office claims environment with emphasis in provider contracting for purposes of systemic administration.
Knowledge of Medicare, Medicaid and Commercial lines of business.