to Third party Payers utilizing Milliman guidelines and Interqual criteria. Coordinates the discharge appeal process... review, discharge planning/quality assurance/infection control. Knowledge of Milliman guidelines and Interqual criteria...
with at least one prominent actuarial modeling software platforms, including but not limited to: Moodys GGY AXIS, FIS Prophet, Milliman ALFA...
applying Milliman and/or Interqual guidelines required. Familiarity with medical coding, reimbursement, and insurance practices...
but not limited to: Moodys GGY AXIS, FIS Prophet, Milliman ALFA/Integrate, Aon Benfield PathWise, Slope, PolySystems, among...
Prophet, Milliman ALFA/Integrate, Aon Benfield PathWise, Slope, PolySystems, among others Strong writing, presentation...
and potential discharge date. Utilizes other application tools to document including Veracity, Optum, InterQual, Milliman, etc. 6...
., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria). Examine and evaluate patient...
or management, preferred. 3. Current BCLS (AHA) certificate preferred. 4. Knowledge of Milliman Criteria and InterQual Criteria...
and apply medical care criteria, such as, but not limited to, InterQual or Milliman Ambulatory Care Guidelines. Shall have a minimum...
and apply medical care criteria, such as, but not limited to, InterQual or Milliman Ambulatory Care Guidelines. Shall have a minimum...