•Performing complete file review of high cost claims with regards to the multidisciplinary notes, TPR charts, physician order’s notes, lab reports, radiology reports, drug chart sheets, consultation notes, nursing notes, progress notes, etc.

•Field hospital deployment or File Audit to be performed when required (Non- Physical or Physical [Provider Visit]) to capture hospital acquired infections, mismanagement, iatrogenic injuries, etc.

•Requesting any medical documentation or finding any missing document which is essential in decision making.

•Performing review of DRG Severity of Illness (SOI) in line with revision of CPT codes / ICD codes, which are being up-coded by the pro...