Medical Reviewer III, Medicare Part A
Job Description:
- Perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare PART A.
- Perform projects or duties as assigned as a Medical Review Specialist.
- Conduct in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles.
- Utilize electronic health information imaging and input medical review decisions by electronic database module.
- Utilize Microsoft Office suite and other software templates as associated source input for claims review.
- Make clinical judgment decisions based on clinical experience when applicable.
- Responsible for review of Medicare Part A claims.
- Meeting quality and production standards.
Requirements:
- Must be a Registered Nurse obtained by either a Bachelor's degree – OR - Associate's degree – OR - Diploma in Nursing.
- At least four (4) years related experience.
- At least three (3) years clinical experience as a Registered Nurse.
- Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
- Ability to keep sensitive and confidential material private.
- Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI).
Benefits:
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off