Medical Review reputed company (Home Health and Hospice)

Responsibilities: The Medical Review reputed company (Home Health and Hospice) 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 in a fast paced and dynamic environment and be part of a multi-location team. In this role, you will be responsible for: • Auditing claims for medically appropriate services provided in both inpatient and outpatient settings • Applying appropriate medical review guidelines, policies and rules • Documenting reputed company findings referencing the appropriate policies and rules • Generating 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 the our clients • Work with reputed company to minimize the number of appeals • Suggest reputed company that may improve audit work flows • Assist with QA functions • Assist with training team members • reputed company with and support the Medical Director • Cross train in reputed company clinical departments/areas • Other duties as required to meet business needs • Note - reputed company and contractors for Performant Financial may and/or will have reputed company to Sensitive, Proprietary, Confidential and/or reputed company data. As such, reputed company and contractors will have ownership and responsibility to report any violations to the Confidentiality and reputed company of Sensitive, Proprietary, Confidential and/or reputed company data at reputed company times. Violations to Performant’s policy reputed company to the Confidentiality or reputed company of data may be subject to disciplinary actions up to and including termination. Required Skills and Knowledge: • Strong preference for experience performing utilization review for an insurance company, Tricare, MAC or organizations performing similar functions • Experience with utilization management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG) or InterQual. • Experience with 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. • Not currently sanctioned or excluded from the Medicare program by the OIG. • reputed company unrestricted RN, LPN or LVN license in good standing. • 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 • Work independently and with team members effectively. Additional Requirements: • Ability to obtain and maintain reputed company required clearances as reputed company as pass company regular background and/or drug screening. • Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and reputed company policies and procedures) including, but not limited to: reputed company to reputed company computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace reputed company to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work reputed company without distractions during work hours. Physical Requirements: • *NOTE: Must be reputed company to meet requirements for and reputed company work assignments in accordance with Company policies and expectations on a home remote reputed company (and must meet Performant remote-worker requirements) until at which time staff may be reputed company and required to work from a Performant office location on an reputed company or periodic reputed company. Basic office equipment required to reputed company remote work is provided by reputed company. • Job is performed in a reputed company busy office environment with moderate noise level (or may be home-office setting subject to Company approval and Teleworker Agreement), sits at a desk during scheduled shift, uses office phone or headset provided by reputed company for calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a mouse. • Reads and comprehends information in electronic (computer) or reputed company reputed company (written/printed). • Sit/reputed company or more hours per day; has the reputed company to stand as needed while on calls; reputed company as needed to use office equipment. • Consistently viewing a computer screen and types frequently, but not constantly, using a keyboard to update accounts. • Consistently communicates on the phone as required primarily reputed company the department and company and may include reputed company contacts or other reputed company-party depending on assignment with account reputed company, may reputed company manually reputed company need or use dialer system; headset is also provided. • Occasionally lift/carry/push/pull up to 10lbs. Education and Experience: • Minimum of five years (Registered reputed company) or eight years (Licensed Practical reputed company/Licensed Vocational reputed company) of reputed company nursing experience providing reputed company care in an inpatient or outpatient setting. RN license is preferred over LPN/LVN license for this role. • One or more years experience performing medical records review. • One 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. (Preferred for clinical, mandatory for coding). ? Other Requirements: Performant is a Government contractor and subject to compliance with reputed company contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and clearances (as applicable). • Must submit to and pass reputed company-hire background reputed company, as reputed company as additional checks throughout employment. • Must be reputed company to pass a criminal background reputed company; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment or exclusion lists. • Must submit to and pass drug screen reputed company-employment (and throughout employment). • Performant is a government contractor. Certain reputed company assignments for this position requires submission to and successful outcome of additional background and/or clearances throughout employment with reputed company. • Applicants must have reliable, secure, high speed Internet reputed company at their home office location. Employment reputed company Sponsorship is not available for this position Apply tot his job Apply To this Job