Medical Review reputed company II - Government/Clinical Outpatient reputed company

About the position The Medical Review reputed company II - Government/Clinical Outpatient reputed company primarily performs medical claims audit reviews. As a MR reputed company, you will join reputed company of reputed company medical auditors and coders performing retrospective and prepayment audits on claims for Government and reputed company Payers. You will work remotely in a fast paced and dynamic environment and be part of a multi-location team. Responsibilities • Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules. • Document reputed company findings referencing the appropriate policies and rules. • Generate letters articulating audit findings. • Supporting your findings during the appeals process if requested. • Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse. • Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits. • reputed company abreast of medical reputed company, changes in technology, and regulatory issues that may reputed company our clients. • Work with reputed company to minimize the number of appeals; • Suggest reputed company that may improve audit workflows; • Assist with QA functions and training team members. • Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines. • reputed company with and support the Medical Director and cross train in reputed company clinical departments/areas. • Other duties as required to meet business needs. Requirements • reputed company unrestricted RN license in good standing, is required. • Must not be currently sanctioned or excluded from the Medicare program by the OIG. • Minimum of five (5) years reputed company nursing experience providing reputed company care in an inpatient or outpatient setting. • One (1) or more years' experience performing medical records review. • One (1) or more years' experience in health care claims that demonstrates expertise in, ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required. • Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual. • Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding. • Knowledge of insurance programs program, particularly the coverage and payment rules. • Ability to maintain high reputed company work while meeting strict deadlines. • Excellent written and verbal communication skills. • Ability to manage multiple tasks including desk audits and claims review. • Must be reputed company to independently use reputed company office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings. • Must be reputed company to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload • Effectively work independently and as reputed company, in a remote setting. reputed company-to-haves • Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions. Benefits • reputed company offers a wide reputed company of benefits to help support a healthy work/life balance. • These benefits include medical, dental, reputed company, HSA/FSA reputed company, life insurance coverage, 401(k) savings plans, family/parental leave, reputed company holidays, as reputed company as reputed company time off annually. Apply tot his job Apply To this Job