The auditor will uncover issues with the way the system is linking the providers fee schedules. The auditor would look at the claims for any alterations (i.e. Modifiers billed but not keyed, denials applied to the claim in error resulting in an underpayment, incorrect data entry not corrected before finalizing resulting in overpayments etc.) This position is not looking at coding or editing. Just reading and applying the policy against the examiners action that altered the payment and whether it was supported by the policy and whether the fee schedule on the provider file is interfacing accurately with the claim.
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