Clinical Investigator

Requisition number: 2386639 Job category: Claims Primary Responsibilities: Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT or diagnosis codes, CMS guideline along with referring to client specific guidelines and member policies Adherence to state and federal compliance policies and contract compliance Assist the prospective team with special projects and reporting Coordinate with all team members and share recent process rela…