as per department guidelines adhering to frequency requirements and standards for quality control performance. • Reports all outlier...
to underpayment or high dollar/outlier payment discrepancies. Audit, research accounts, payment posting, and contractuals to confirm...
. -Retrieves information for the Physician Advisors as needed. -Works the DNFB report to determine outlier days, approved days...
data to Client vital information to effect lower claims error rate and reduce outlier billing patterns Demonstrated data...
to identify financial irregularities, duplicate payments, outlier transactions, or other risk indicators. Develop training...
to identify financial irregularities, duplicate payments, outlier transactions, or other risk indicators. Develop training...
and communicate findings through clear visuals and summaries Support AI/ML-driven analytics, including anomaly detection, outlier...
/QC checks (sanity checks, outlier detection) to ensure data integrity. Generate clear visualizations and concise...
contracts (fee schedules, DRG/APC, per diem, percent-of-charge, case rates, carveouts, stoploss/outlier, multiple procedure...
globally Design and apply customer segmentation and pricing strategies across portfolio segments Monitor outlier pricing...