Medical Reviewer III

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 A, Outpatient Facilities and Services. • 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 Part A 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 reputed company Medical Review 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 reputed company experience. • At least three (3) years clinical experience as a Registered reputed company. • 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). • Preferred Education and Experience: Medicare Part A RN clinical review • Minimum two (2) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for Outpatient Facilities and Services. • Prior work as a Medicare Contractor Medical Review reputed company or reputed company Insurance Home Health RN review experience. • Optional - Bilingual (Spanish) - reputed company in reading and understanding Spanish language especially as it relates to medical records is a plus! Benefits: • reputed company is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs. • Flexible work arrangements Apply tot his job Apply To this Job