1. what is your title and duties/responsibilities for the company? i am an rn. my title is site review consultant. i work for medassurant, and basically, i abstract information from the medical records depending on what the project is. currently my project is claims integrity. we abstract information to identify overpayments or underpayments, whether the medical codes used for billing are correct, and whether the provider is lacking sufficient documentation to support his billing claims.
2. who do you work with? (children, animals co-workers, etc) i usually work from home and don't really interact with other healthcare providers. when i visit clinics, i interact with the him department.
3. where are you at (office, hospital, court house, out in the field, etc) mostly at home; sometimes i work out in the field.
4. what are you doing? (calcculating, designing, training. etc) pls see above.
5. what challenges do you face? reading the provider's handwriting. i can only give credit for the words that i can read, so even if the provider took the time and effort to examine the patient, i cannot give credit to his work if he didn't document it.... or if i cannot read his documentation.
6. what are the rewards of your position? i play a part in combating fraud, abuse, and waste. we help medicare and other health insurance plans recoup the overpayment they gave to the provider. in some cases, it's the providers that we help to increase their income when it turns out they were underpaid.
7. what qualifications do you need to do your job? (aa/as, ba/bs, ma/ms, ph.d) you must be an lpn or an rn. i think my company is also hiring coders and nursing assistants. the salary, as you know, varies based on your credentials.
8. what is the course of a typical day? i download charts. i read one chart; i look for information that i need, then i enter the data in their software. after that i open another charts and do the same thing. the reviewed charts are uploaded and sent back to the main office for further processing. then i obtain another set of charts that i have to review.