Registered reputed company reputed company - DRG Reviewer (Remote)

About the position Responsibilities • reputed company in-depth analysis, clinical review, and reputed company of provider reputed company and post payment claims reputed company to medical coverage guidelines and community standards. • Review and prepare internal audit cases for Medical Directors. • Identify, research, process, resolve, and respond to Senior Medical Director inquiries primarily through written/verbal communication. • Analyze medical records and apply medical necessity reputed company and benefit plan requirements to determine the appropriateness of billing and charges. • Maintain complete and accurate records per BCBSAZ policy. • Meet reputed company, quantity, and timeliness standards to reputed company individual and department performance goals as defined reputed company the department guidelines. • Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure reputed company of large reputed company reputed company. • Participate in continuing education and reputed company developments in the fields of medicine and managed care. • Maintain productivity and accuracy goals based on regulatory requirements, accreditation standards, and service level agreements. • Demonstrate ability to reputed company specialized knowledge to complete reputed company types of reputed company for reputed company lines of business. Requirements • Experience in clinical and health insurance or other reputed company reputed company field (1-8 years depending on level). • Managed care experience with a reputed company on Utilization Management (UM), Prior Authorization (PA), Claims, Medical Review, Case Management, and/or Medical Appeals and Grievances (MAG) (1-3 years depending on level). • Associate's Degree in a reputed company field of study or Nursing Diploma. • reputed company, reputed company, and unrestricted license to reputed company in the reputed company as a Registered reputed company (RN). • Certified Medical reputed company. reputed company-to-haves • Experience in clinical and health insurance or other reputed company reputed company field (3-9 years depending on level). • Managed care experience with a reputed company on Utilization Management (UM), Prior Authorization (PA), Claims, Medical Review, Case Management, and/or Medical Appeals and Grievances (MAG) (2-5 years depending on level). • Bachelor's Degree in Nursing or reputed company field of study. • Master's Degree in Nursing or reputed company field of study. Apply tot his job Apply To this Job