Job Description

JOB SUMMARY:

The Research Analyst is responsible for medical records, quality assurance/utilization review and audit preparation. The Research Analyst also provides general support for the Coding Department.

JOB RESPONSIBILITIES

ESSENTIAL FUNCTIONS:

• Provide accurate data for Legal requests, such as ledgers, itemized statements, 1500s and medical records as quickly and accurately as possible.
• Retrieve activities for the HEDIS requests.
• Ability to accurately interpret medical documentation to ensure they are providing accurate data requested (lab results/orders).
• Review Pre and Post payments.
• Provide a detail-focused review of clinical documentation to ensure quality, regulatory compliance, and audit readiness. Maintain all medical records and charts.
• Assist in utilization review and research programs.
• Handle documentation management to ensure documents received by the coding department are scanned into the correct patient chart.
• Assist the department in requesting additional clinical documentation if needed.
• Abide by all regulatory, company and departmental regulations, policies and procedures, including the Corporate Compliance Program.
• Contribute to a positive work climate and to the team effort of the department and company.
• Support PathGroup's mission, vision, goals and management decisions.
• Become familiar with and abide by the Corporate Compliance Program and all corporate policies, including the Privacy and Security policies.

NON-ESSENTIAL FUNCTIONS:

• Work with other departments within PathGroup and subsidiaries.
• Nothing in the job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
• Other duties as assigned.

EDUCATION & LICENSURE:

• High school diploma or GED is required.

REQUIREMENTS:

• One to two years of job-related experience is required.
• PC proficiency required.
• Ability to prioritize projects appropriately and attentiveness to detail required.
• Effective oral and written communication skills and excellent interpersonal skills required.
• Ability to learn and adapt quickly, strong attention to detail, and ability to maintain confidentiality
• Excellent organizational and computer skills, as well as spoken and written communication skills
• Ability to work effectively as a team member and meet tight time deadlines

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