Hafsa Tazeen Sana

•Review healthcare records, coding practices, and billing procedures to ensure accuracy, compliance with regulations, and adherence to best practices.
•Analyze patient records to verify the completeness, accuracy, and timeliness of documentation, ensuring it meets regulatory requirements and facilitates proper reimbursement.
•Monitor compliance with relevant laws, regulations, and organizational policies related to healthcare documentation, coding, billing, and reimbursement.
•Conduct audits to assess the quality of care provided, identifying areas for improvement and recommending corrective actions to maintain high standards of patient care.
•Evaluate coding practices to ensure appropriate assignment of diagnostic and procedural codes, maximizing reimbursement while minimizing the risk of audit penalties.
• Evaluate requests for medical procedures, treatments, and services to determine eligibility, medical necessity, and compliance with insurance guidelines and healthcare policies.
•Review documentation and medical records to assess the appropriateness of requested services, ensuring they meet established criteria for approval.
•Maintain detailed records of audits, approvals, denials, and related activities, preparing reports and summaries as needed for internal review, regulatory compliance, and quality improvement initiatives.