Qiu Xie

Lead of Medical Auditor - Rn Specialist @Kaiser Permanente

Oakland, CA, US

Provides clinical expertise to other departments such as Workers Compensation, CSA/MSA outside case management in areas related to hospital and physician billing practices and cost containment activities. Works with legal department when indicated to resolve payment disputes. Serves as a consultant to CSA Continuing Care teams and case managers on issues on non-pricing, billing problems, procedures and benefit compliance issues. Identifies opportunities for cost containment. Works with regulatory compliance for review of benefit. Responsible for review ICD-10, CPT/HCPCS codes, medical records, UB-04 and CMS1500 forms and Kaiser Permanente internal systems (OTRS, Tapestry, etc.). Determines if bills are payable or if additional information is needed, identification of potential fraud issues. Works with support staff as a resource for decision-making and medical terminology. Plans and organizes daily work to meet compliance timeframes. Provides feedback to manager to ensure work is within compliance. Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente\'s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization. Acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente\'s policies and procedures.

Merritt College

Associate's Degree

University of San Francisco

Master's Degree

Boston Reed College

Certificate

Wuhan University

Engineer's Degree