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 Medicare claims processing systems to monitor 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 findings at Prepay Committee Meetings.
• Communicates with UPIC legal team, RFI Coordinator, and Law Enforcement to manage case/investigation information.
• Works with 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.
• Monitors and creates reports indicating monitoring of identified administrative actions.
• Attends UPIC Medical Review meetings and updates tracking systems with meeting information.
• Collaborates with other entities to coordinate and manage workload transitions.
• Provides training and technical advice to team members.
• Collaborates with Quality Director/Officer on ISO initiatives to improve operational systems, processes, and policies.

Education & Work Experience

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

Qualifications

• Under close supervision, works closely with manager to prioritize efforts.

Skills

• Knowledge of Medicare claims processing systems.
• Ability to communicate effectively via written and verbal means.
• Proficiency in creating and reviewing reports.
• Experience working with legal teams and law enforcement.
• Ability to manage and track administrative actions.
• Technical skills in internal and external tracking systems.
• Strong collaboration and teamwork skills.
• Ability to provide training and technical advice.
• Understanding of ISO initiatives and their impact on operational systems, processes, and policies.

Benefits

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities. Drug-Free Workplace.

Pay

N/A

Schedule

N/A

Benefits

N/A