Clinical Consultant ....
Clinical Consultant - Clinical Dispute Resolution and Coding
Posted on :
01-03-2024
Employer Active
1 Vacancy
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Job Description
Req ID : 2582672
Job Requisition: Clinical Consultant - Clinical Dispute Resolution and Coding
Job Summary: The Clinical Consultant will play a pivotal role in supporting clinical review projects and managing the clinical coding associated with those contracts. The ideal candidate will bring extensive clinical expertise, a deep understanding of independent medical review processes, and a proven history in clinical coding.
Key Responsibilities:
- Clinical Review Support:
- Participate in clinical review projects, working closely with cross-functional teams to analyze and resolve clinical disputes efficiently.
- Participate and conduct state hearings as needed in support of assigned projects.
- Collaborate with legal and compliance teams to ensure adherence to regulations and contractual obligations during dispute resolution processes.
- Clinical Coding:
- Oversee and manage the clinical coding processes related to projects, ensuring accuracy and compliance with industry standards.
- Provide guidance to coding teams and contribute to continuous improvement initiatives in clinical coding practices.
- Documentation and Reporting:
- Maintain comprehensive documentation of clinical review resolution activities, ensuring a clear and auditable trail of actions taken.
- Generate regular reports on clinical coding accuracy, clinical review outcomes, and key performance indicators for senior management.
- Collaboration and Communication:
- Collaborate effectively with internal stakeholders, including legal, compliance, finance, and operational teams.
- Communicate with external parties, including clients and regulatory bodies, to address clinical coding and dispute resolution matters.
Qualifications:
- Minimum of 10 years of experience in a clinical review role, with a focus on medical review and clinical coding.
- Bachelor’s degree in nursing required.
- Current CPC coding certification is a plus.
- Strong knowledge of Industry Standards and regulations related to clinical coding and review.
- Excellent communication and interpersonal skills.
- Proven ability to lead and collaborate in a cross-functional team environment.
Employment Type
Full Time
Key Skills
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