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University of California, Los Angeles | Los Angeles, California | United States | about 2 months ago
JOB DUTIES Description As the Clinical Documentation Integrity Specialist – Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and documentation, working closely
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of medical terminology, particularly urology. General knowledge of third party insurances, government programs and other insurance agencies for purposes of assigning financial class codes and obtaining any
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compounding, participation in code response, and adherence to all regulatory and accreditation requirements. This role provides direct supervision and oversight of pharmacy technicians to ensure the technical
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, the Knox-Keene Act, Health & Safety Codes, etc., Familiarity with medical terminology, CPT codes, HCPCS codes, health networks, IPAs, HMOs, PPOs, PCPs, and contract affiliations Excellent verbal and written
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claims to commercial, government, and self-pay payers in compliance with billing regulations and timely filing guidelines Editing claims to ensure accurate coding, documentation, and payer
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billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue/HCPCS coding Understanding of provider network/IPA arrangements and reimbursement methodologies, etc. Knowledge
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administrative code • Develop and execute key agent and provider strategies, tools, training, and collateral that enhance sales • Manage specific clinic locations in assigned territory to drive leads that convert
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, coordinating with Utilization Review, HIMS, Coding, Compliance, and Revenue Integrity to resolve missing or incomplete documentation. Review patient and account information to obtain demographic
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tasks to ensure adherence to the study protocol and applicable regulations, such as institutional policy and procedures, FDA Code of Federal Regulations (CFR), and ICH Good Clinical Practice (GCP). In
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of the California Code of Regulations. Section 1399.540 states “A physician assistant may only provide those medical services which he or she is competent to perform and which are consistent with the physician