Beth Houston

· Data review, clinical assessment, medical status research and clinical experience

· Produce a quarterly department newsletter to A&H Division

· Create and regularly publish and present white paper articles about clinical trends, treatments and highlight successes of the clinical assessment department

· Create an information library/database generated from research as it pertains to diseases, treatment and drugs impacting cost/pricing

· Sponsor lunch/learn sessions to share findings involving emerging risks, e.g. new costly conditions/treatments or drugs

· Operate as clinical contact for vendors/cost containment

· Review and clear system generated claims tasks. Clinical Research review on complicated claims.

· Demonstrates ability to effectively and efficiently research current usual and customary billing for procedures, diagnostics, inpatient stays, etc.

· Reviewing medical data, policy data and claim details. Identifies risk by applying consistent risk analysis standards, and then provides recommendations.

· In coordination with the Claims Department and other departments, as applicable, develop and implement a pre and post-payment review system focused on events that generate high dollar claims.