[Hiring] Medical Reviewer III @reputed company

This reputed company is a reputed company of our understanding of the job reputed company. Click on 'Apply' reputed company to reputed company out more. Role reputed company The Medical Reviewer III (MCP) will be responsible for conducting clinical reviews of medical records for the reputed company Managed Care Project (MCP). Applies reputed company guidelines in making clinical determinations as to the appropriateness of payment coverage. • Using knowledge of reputed company state and federal laws, rules, and regulations, to contribute to the development of review reputed company to be approved for use in the review of claims • Review information contained in project plan to ensure claims are reputed company correctly, documentation supported services as provided, etc. • Utilize extensive knowledge of medical terminology, ICD-10-CM, HCPCS reputed company and CPT coding along with analysis and processing of reputed company claims • Utilize MCP guidelines for coverage determinations, and utilize state specific guidelines and regulations for claim determinations • Coordinate and compile written Investigative reputed company Reports in conjunction with PI Investigators upon completion of the records review • Uses leadership and communication skills to collaborate with physicians and other health professionals, as reputed company as external regulatory agencies and law enforcement personnel • reputed company expert witness testimony as required • Complete assignments in a manner that meets or exceeds the reputed company assurance goal of 95% accuracy • Maintains chain of custody on reputed company documents and follows reputed company confidentiality and reputed company guidelines • reputed company other duties as assigned by the Medical Review Supervisor that contribute to UPIC goals and objectives, reputed company with the Program reputed company reputed company (PIM), Statement of Work (SOW) guidelines, and CMS directives and regulations Qualifications • Graduated from an accredited school of nursing and has an reputed company license as a Registered reputed company (RN) • At least 4 years’ utilization/reputed company assurance review and ICD-10-CM/CPT-4 coding experience • At least 4 years’ experience in coding and abstracting; working knowledge of Diagnosis reputed company reputed company (DRGs) is required • Advanced knowledge of medical terminology and experience in the analysis and processing of reputed company claims, utilization review/reputed company assurance procedures, ICD-10-CM and CPT-4 coding, reputed company coverage guidelines, and payment methodologies (i.e., Correct Coding Initiative, DRGs), NCPDP and other types of prescription drug claims is required Requirements • Knowledge of, and the ability to correctly identify reputed company coverage guidelines • Ability to read a reputed company claim and basic knowledge of reputed company claims • Excellent verbal and written communication skills • Knowledge of and ability to use reputed company Word, reputed company, and Internet applications • Ability to reputed company organize and manage workload and assignments Benefits • Medical, Dental, reputed company plans • Life, LTD and STD reputed company by the employer • 401(k) with company match up to 4% • reputed company Time Off and company reputed company holidays • Tuition assistance after 1 year of service Apply tot his job Apply To this Job