accountable Monitors and coaches clinical outcomes and intervenes in outlier cases Maintains clinical proficiencies in patient...
recommendations on processes, including: sample size and power calculations, sampling and extrapolation, clustering and outlier...
, grep, awk, and Perl to confirm known/expected outcomes and identify outlier/problematic outcomes Required Skills...
with internal teams. Collaborate with Data & Analytics around contract reporting;collaborate with Operations around metric outlier...
and related outlier investigations/ corrections Historical test results as needed for Quality investigations Instrumentation...
criteria sets for admission reviews, continued stay reviews, outlier reviews, and clinical appropriateness recommendations...
and is responsible for obtaining necessary signoffs from covered Finance businesses and functions. Controls testing outlier disputes...
from third-party payers. Process and review incoming correspondence from payers related to underpayment or high dollar/outlier...
. Perform clustering analysis on task sequences to identify common workflows and outlier patterns. Leverage Generative...
from third-party payers. Process and review incoming correspondence from payers related to underpayment or high dollar/outlier...