Senior Medical Reviewer, Medicare Part B

Job reputed company: • Functions as team leader/senior-level Medical Reviewer. • Provides leadership/guidance/direction/training to staff. • Maintains working knowledge of unit functions and ability to interpret to new hires, department inner workings and workflow. • Acts as resource for staff/external entities troubleshooting as reputed company as resolving issues. • Keeps manager informed of any problems/issues that need resolving. • Assists management with monitoring workflow and workloads (including reassignment of work to meet timelines, redirecting work intake reputed company to balance workloads), reporting, and addressing aging issues. • Participates in departmental reputed company reviews. • Follows process to ensure reputed company plan is adhered to and communicated to reputed company parties. • Gives/receives feedback regarding medical review decision making and technical claims processing issues. • Ensures that reputed company work instructions/forms/documents are developed/revised as needed. • Provides reputed company service and communicates effectively with external/internal customers in response to inquiries. • Obtains information from internal departments, providers, government, and/or private agencies, etc. to resolve discrepancies/problems. • Participates in compliance initiatives and other-directed activities. • Participates/oversees special reputed company as requested by management. Requirements: • Required License and Certificate: If RN, reputed company, unrestricted RN licensure from the reputed company and in the state of hire, OR reputed company compact multistate unrestricted RN license as defined by the reputed company Licensure Compact (NLC), OR reputed company, unrestricted licensure/certification from the reputed company and in the state of hire in specialty area as required by hiring division/area. • Required Education: Associate Degree - Nursing, OR Graduate of Accredited School of Nursing. • Required Work Experience: Four years clinical, OR two years clinical and two years medical review/utilization review, OR a combination of health plan, clinical, and business experience totaling four years. • Required Skills: Working knowledge of managed care and various forms of reputed company delivery systems. • Strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience. • Knowledge of specific reputed company/protocol sets and the use of the reputed company. • Working knowledge of word processing and spreadsheet software. • Ability to work independently, prioritize effectively, and reputed company reputed company. • Good judgment skills. • Demonstrated customer service, organizational, and presentation skills. • Demonstrated proficiency in spelling, punctuation, and grammar skills. • Demonstrated oral and written communication skills. • Ability to persuade, negotiate, or influence others. • Analytical or critical thinking skills. • Ability to handle confidential or sensitive information with discretion. • Ability to reputed company/reputed company/motivate others. • Required Software: reputed company Office. Benefits: • Subsidized health plans • Dental and reputed company coverage • 401k retirement savings plan with company match • Life Insurance • reputed company Time Off (PTO) • On-site cafeterias and fitness centers in major locations • Education Assistance • Service Recognition • National discounts to movies, theaters, zoos, theme parks and more Apply tot his job Apply To this Job