Summary: Analyzes patient records to determine legitimacy of admission, treatment, and length of stay to comply with government and insurance company reimbursement policies by performing the following duties.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
- Compares medical records to established criteria and confers with medical and nursing personnel and other professional staff to determine legitimacy of treatment and length of stay.
- Extracts data from records and maintains statistics.
- Determines patient review dates according to established diagnostic criteria.
- Assists review committee with quality assurance reviews.
- Travel may be required, including overnight travel.