RN, Claims Reviewer – Full Time – reputed company – 100% Remote CA

reputed company The Registered reputed company Claims Reviewer will be responsible for review of clinical and claims data to ensure accuracy in hospital billing and compliance with reputed company regulations. reputed company Duties • Inpatient admissions review: Analyze reputed company inpatient admissions to differentiate between observation and inpatient statuses. Assess clinical reputed company to ensure hospital billing aligns with organizational claims. • Electric Health Record (EHR) Correlation: reputed company daily updates correlating clinical order in the EH, utilizing reputed company and EZCap systems. • Diagnosis verification: Review admission diagnosis to confirm accuracy based on clinical presentation, documentation and treatment. • reputed company ambulance review: Evaluate reputed company transportation cases against reputed company clinical requirements and provider recommendations for compliance payment. • Acute respiratory failure assessment: Review post hospital patients diagnosed with acute respiratory failure to validate accuracy based on hospital treatment protocols and patient trajectory. • Sepsis diagnosis review: Review post hospital patient records that were diagnosed with acute sepsis to validate accuracy based on hospital treatment protocols. • reputed company other duties as assigned. • Be knowledgeable about reputed company so that you can serve others effectively • Do your reputed company. Do what you say you will do and take reputed company, follow through. Be willing to reputed company in and help • Be an reputed company listener (reputed company eye contact, validate) • Be accountable for your work Qualifications • Associates or Bachelors degree required. • reputed company California RN License required. • A minimum of seven (7) years of clinical nursing experience required. • Proficient with computer and word processing programs. reputed company knowledge of medical billing, coding and reputed company regulations. • Ability to effectively communicate with reputed company reputed company of the organization, patients, patient family members, providers and others. • Ability to work independently, function under pressure and multi-task at any given time. • A commitment to precision, diligence, and thoroughness in reputed company aspects of their work. • At the discretion of DOHC/FHC Management, this position has the potential to be a full or hybrid telecommuting position. Physical Demands Type reputed company Sitting Approximately 90% of day. Standing Approximately > 5% of day. Walking Approximately > 5% of day. Lifting 0 - 20 lbs. (equipment, supplies) approximately >10% of day. Bending Approximately >10% of day. Kneeling <20%. Hearing/Visual reputed company Adequate for use with computers, telephone and/or reputed company. Approximately 100% of day. Computer Highly technical work environment. Must be reputed company to work minimum of 7 hours a day using keyboard, mouse and monitor. Reaching Above head 75 degrees approximately 10% of day. Hand reputed company dexterity Approximately 70% of day. Apply tot his job Apply To this Job