MR/PI Coordinator I

Job Summary

Captures and maintains operational activities related to medical review and program integrity processes.

Essential Functions

• Implements, revises, and removes claims system edits.
• Works within the Medicare claims processing systems to monitor the status of UPIC initiated edits.
• Sends out correspondence such as educational letters, prepay notification letters, and suspension correspondence.
• Responds to client inquiries via written or verbal communications.
• Makes and reviews reports showing the results of system edits and presents these findings at the Prepay Committee Meetings.
• Initiates and maintains communication with the UPIC legal team, RFI Coordinator, and Law Enforcement to manage the transfer of case/investigation information.
• Works closely with the UPIC legal team in response to FOIAs, RFIs, ALJ Hearings, Congressional Complaints, and other related activities.
• Tracks and creates reports related to the results of upper level appeals.
• Works within internal and external tracking systems to monitor the status of payment suspensions, zone restrictions, and other cases or investigations as assigned.
• Makes and creates reports indicating monitoring of identified administrative actions.
• Attends the UPIC Medical Review meetings and updates tracking systems with information from the meeting.
• Captures and manages the transition of workloads, and serves as the interface with other entities.
• Provides training and technical advice to team members.
• Collaborates with Quality Director/Officer on ISO initiatives to improve operational systems, processes, and policies to enhance information flow, management reporting, business process, and organizational planning.

Qualifications

• Minimum High School Diploma or GED required.
• 0 - 2 years of experience required; 2 - 4 years preferred.

Benefits

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities. Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens.