Health Care Excel Work Values

Daily Duties at Health Care Excel:

Identified and pursued provider overpayment for issues such as mistaken coding, to fraud and abuse, and extracted documentation to support conclusions, prepared and maintained reports to support determinations. Performed onsite and medical record audits, and recommended self-audits of providers for the purpose of analyzing, investigating, and profiling potentially aberrant practices. Conducted entrance and exit conferences with providers in a professional manner, shared relevant, accurate information regarding the Surveillance and Utilization Review function and audit results. Analyzed and compared findings to peer groups to detect aberrant practices, and assisted in the development of profiles of health care delivery and utilization patterns of providers and recipients based on defined parameters and guidelines. Used appropriate judgment and analysis to draw conclusions for pre-payment review, follow-up audits, and referral to Medicaid Fraud Control Unit (MFCU), or case closure. Performed appropriate research for audit findings information in adherence to necessary timeframes and deadlines. Created appropriate correspondence and communications, and managed appropriate paper and electronic documents in accordance with contract-specific and company document control guidelines, including version control and proofreading. Maintained a high level of expertise in the use of desktop applications, spreadsheet and CD-ROM software, the Internet and Electronic Medical Records. Participated in Provider, Recipient and Stakeholder Meetings

What they like about Health Care Excel:

A hiring company that offers alternative approaches to pay, performance bonuses, and/or equity in the firm is very attractive to you. You're generally less interested in working for an organization offering only traditional, salary-based compensation, one with limited opportunity to acquire equity in the firm, or one that does not actively promote skill development. In addition, you are more likely to choose a company that offers a variety of internal career options, with defined career paths. You view the learning of new skills and development of your expertise as key to your career advancement. These aspects of an organization may become even more important to you as you progress in your field, and are especially critical if you change career or occupation.

Tags

utilization review, clinical auditing, national quality initiatives, fraud and abuse investigation, Microsoft Word, Excel, Outlook, Access, physician education, oversight reporting, trending, profiling

Skills

Microsoft Word, Excel, Outlook, Access, Crystal Reporting

These are some of the questions we asked our climbers about their experiences with Health Care Excel: