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Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
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Description The Payment Integrity Professional 2 uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our ..
... speak with contracted external physicians, physician groups, facilities, or community groups ... upon request of the attending physician Participates in HCO MD Inter-Rater ... Development forum (TAF) Collaborates with..