Clinical Analysts to perform DRG Audit Services which shall include documentation verification coding validation and clinical validation of billed Services.
Clinical Analysts will review all claims made available in the audit system and identify those claims that are incorrect or are inconsistent with the training materials standards and policies and procedures provided by the client.
Clinical Analysts shall provide a payment recommendation based on that review through the audit system which shall include documentation of the clinical Analyst s findings including the rationale behind the findings or conclusion of no finding or a problem with the audit which requires escalation.
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