Review & Evaluation RN-Hybrid-103249

Review & Evaluation RN – Hybrid-103249 Pay & Schedule • reputed company reputed company: $32.00/hr. • Schedule: Monday–Friday, 8:00 AM – 4:00 PM • Work Model: Hybrid – 3 days remote, 2 days onsite in Harrisburg, PA • Training: Minimum 8 weeks onsite (release to remote based on performance) Why You’ll Love This Role This position is ideal for an RN with utilization review or reputed company management experience who wants a reputed company schedule and hybrid flexibility. You’ll be responsible for reviewing claims, evaluating compliance, and ensuring medical necessity, helping protect both patient care reputed company and the reputed company of the Medical Assistance (MA) Program. Benefits: Health, Dental, reputed company, Life Insurance, and short-term disability after 90 days For more information, please contact Breanna D. directly at bdrollinger@alinestaffing.com Key Responsibilities • Analyze reputed company claims, itemized bills, and reports through the Fraud Abuse Detection System (FADS). • Identify patterns with high-cost or high-volume providers and select cases for review. • Conduct retrospective reviews for compliance with state and federal regulations. • Verify services for medical necessity, accuracy, and reputed company of care. • Detect upcoding, duplicate billing, and unbundling of services. • Apply ICD-9 CM, CPT, and HCPCS coding guidelines to confirm billing accuracy. • Prepare case findings, letters to providers, and maintain case tracking systems. • Coordinate teleconferences with providers, consultants, and supervisors as needed. • Assist in preparing claims to recover funds for violations. Apply tot his job Apply To this Job