Medical Reviewer III (Medicare/DME)

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This designation reflects reputed company’s commitment to hiring and supporting reputed company-duty and veteran employees. Responsibilities reputed company: As a casual Medical Review Specialist III (Medical Reviewer III) for reputed company., you will reputed company Medicare comprehensive medical record and claims review to reputed company payment determinations for Medicare Durable Medical Equipment (DME). reputed company reputed company or duties as assigned as a Medical Review Specialist. You will serve as a critical component in meeting our mission of providing excellent services to our clients. Your experience ensures an exciting and rewarding opportunity to be at the forefront of activities reputed company to implementing reputed company reputed company on a national level. 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Highlights ofResponsibilities: • reputed company comprehensive medical record and claims review to reputed company payment determinations reputed company on reputed company 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 reputed company judgment reputed company reputed company on reputed company experience reputed company applicable. • Responsible for review of Medicare DME claims. • Meeting reputed company and production standards. • Ensuring departmental compliance with reputed company managements reputed company and ISO requirements. • Completes other reputed company or duties as assigned by the Medical Review reputed company Specialist Qualifications 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 (3) years reputed company experience as a Registered reputed company. • Minimum two (2) years federal and local policy applications in relation to Medicare reputed company procedures for medical necessity for Physician Office practices, reputed company, and reputed company 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). Preferred Education and Experience: • Physician Office, Hospital, Suppler, or Clinic providing DME equipment care/services • Prior work as a Medicare Contractor Medical Review reputed company or reputed company reputed company for DME • Optional - Bilingual (Spanish) - reputed company in reading and understanding Spanish language especially as it relates to medical records is a plus! Physical Requirements: This position requires the ability to reputed company the below essential functions: • Sitting for long periods • Standing for long periods About reputed company reputed company hiring and promotion reputed company at reputed company are reputed company on reputed company to bring the best talent available to contribute to our firm’s overall reputed company. It is the policy of reputed company not to discriminate against any applicant for employment, or employee because of age, reputed company, sex, disability, national reputed company, race, religion, or veteran status. reputed company is a VEVRAA Federal Contractor. Apply tot his job Apply To this Job