Clinical Data Coordinator

• Analyze requested claims data to identify pre- and post-pay audit trends and claim denial trends by facility location, payers, and service lines
• Prepare reports reflecting RAC audits, insurance and third-party activities, and claim denials
• Log audit and claim denial requests, review findings and determinations in the audit tracking database, and evaluate logging and tracking processes
• Log all claim denials
• Identify workflow roadblocks and make recommendations to management and the software vendor
• Develop and maintain relationships with clients, staff, management, and insurance/vendor representatives
• Communicate audit activity results through written reports and oral presentations to management
• Complete audit follow-up and closure
• Create educational materials for audit tracking software and provide ongoing staff training
• Review and file incoming mail via fax, scanning, and email, assigning it to appropriate work queues
• Coordinate appeals sent via RightFax and maintain an appeals database
• Assist clinical audit and follow-up teams with write-offs and management work queues
• Attend monthly insurance/payer vendor meetings and stay current on policy and billing updates

Audit Clinical Data Coordinator

• Analyze requested claims data to identify pre- and post-pay audit trends and claim denial trends by facility location, payers, and service lines
• Prepare reports reflecting RAC audits, insurance, third-party activities, and claim denials
• Log audit and claim denial requests, review findings and determinations, and evaluate logging and tracking processes
• Identify workflow roadblocks and make recommendations to management and the software vendor
• Develop and maintain relationships with clients, staff, management, and insurance/vendor representatives
• Communicate audit activity results through written reports and oral presentations to management
• Complete audit follow-up and closure
• Create educational materials for audit tracking software and provide ongoing staff training
• Review and file mail received via fax, scanning, and email, assigning it to appropriate work queues
• Coordinate appeals sent via RightFax and maintain a database of appeals
• Assist clinical audit and follow-up teams with write-offs and management work queues
• Attend monthly insurance/payer vendor meetings to stay current on policy and billing updates