Teams at Nova Healthcare Administrators, Inc.

Adjudicate and adjust medical and dental claims per plan policies, research and resolve coding/payment issues, maintain accuracy and productivity targets, respond to member/provider inquiries, and communicate with internal teams to ensure correct claim payments and process improvements.

Senior Clinical & Coding Specialist reviews complex inpatient coding and clinical cases, conducts audits, validates diagnosis/procedure coding, manages appeals and external dispute processes, trains staff, analyzes audit trends, recalculates reimbursement, and presents audit results to leadership.

Integrate multiple healthcare data sources to produce reports and complex analyses of quality measure trends, support HEDIS/QARR submissions, model gap-closure opportunities, develop custom measures, present findings, validate data, and lead improvement initiatives while mentoring junior analysts.