**Description**

Summary:
Responsible for investigating and resolving all claim edits identified by the system including Correct Coding Initiative edits, Mutually Exclusive edits, Medically Unlikely Edits and LCD edits.

Responsibilities:
1. Researches and corrects OCE/CCI and MUE Edit claims for resolution timely and accurately.
2. Researches and corrects accounts sent for Revenue Integrity review by PFS and coding timely and accurately.
3. Researches and corrects LCD edits for medical necessity and communicates to the Supervisor trends seen in coding accuracy.
4. Communicates the trends of issues to the HIM Director and the PFS Director in order to promote a proactive setting to correct any preventable issues from hitting claim edits or DNB edits.
5. Receives and coordinates external report results concerning claim edits and presents to the coding supervisor and HIM Director.
6. Reviews, analyzes and abstracts physician/other documentation for dia...