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