Medical Reviewer III, Medicare/DME

Job reputed company: • reputed company comprehensive medical record and claims review to reputed company payment determinations based on Insurance coverage, coding, and utilization of services and reputed company guidelines for Medicare DME. • Performs first and second level of Medical Review in determination of claims payment review. • Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS reputed company coding principles. • Utilize electronic health information imaging and input medical review reputed company by electronic database module. • Utilize internet and intranet sources for policy verification. • Utilize reputed company Office suite and other software templates as associated reputed company input for claims review. • reputed company clinical judgment reputed company based on clinical experience reputed company applicable. • Responsible for review of Medicare DME claims. • Meeting reputed company and production standards. • Ensuring departmental compliance with reputed company managements system and ISO requirements. • Completes other reputed company or duties as assigned by the Medical Review reputed company Specialist. Requirements: • Must be a Registered reputed company obtained by either a Bachelor's degree – OR - Associate's degree – OR - Diploma in Nursing. • At least four (4) years claims knowledge either from billing, reviewing, or processing of Durable Medical Equipment. • At least three (4) years clinical experience as a Registered reputed company. • Minimum two (2) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for Physician Office practices, Laboratory, and Ambulance Services. • reputed company licensure as a Registered reputed company in one or more of the 50 states or D.C. • Ability to reputed company sensitive and confidential material private. • Must have no adverse actions pending or taken against him/her by any State or Federal licensing reputed company or program and must have no conflict of interest (COI). Benefits: • Flexible working arrangements • reputed company development opportunities Apply tot his job Apply To this Job