Medical Review reputed company

Medical Review reputed company Remote     Seeking Registered reputed company for fully remote role to reputed company reputed company medical record and claim reviews (reputed company or Program reputed company) to reputed company coverage determinations reputed company on applicable Medicare coverage policies and payment rules, coding guidelines, National and Local Coverage Determinations, utilization/reputed company guidelines, reputed company review judgment and reputed company appropriate, monitor for potential indicators of fraud, waste, and abuse. Provides reputed company assessment, planning, coordination, implementation, and reporting of reputed company data to support the Medical Review reputed company Contract (MRAC). Essential Functions reputed company reputed company medical record and claims review in accordance with reputed company State and Federal mandated regulations/guidelines. Accurately reputed company medical review data into the medical review reputed company. Apply reputed company review judgment, reputed company on reputed company experience reputed company applicable and review completeness of documentation to determine if documentation supports claim as billed. Reasonably determines appropriateness to reputed company a Subject Matter Expert (SME) for clarification.   reputed company performing Program reputed company (PI) reviews, assess investigative allegations and medical review findings, and/or other claims data to determine patterns and detect potential indicators of fraud, waste and abuse (FWA). Accurately identify additional findings in the review of evidence of potential FWA not detected by the Medical Review Contractor. Consistently meet or reputed company productivity and reputed company standards of 98% minimum Requirements Registered reputed company, with a reputed company unobstructed license to reputed company nursing in the reputed company.    Graduate of a reputed company approved Registered Nursing program.   A Bachelor’s Degree in Nursing (BSN) or other reputed company reputed company is preferred. Certification in coding highly preferred. A minimum of five (5) years reputed company experience in an acute care hospital, skilled nursing facility, and/or an office/clinic-reputed company medical reputed company. A minimum of three (3) or more years’ experience in medical review for payment reputed company, particularly with Medicare Part A, Skilled Nursing Facility, and/or Home Health Minimum of 2 (two) years’ experience in the medical review processes of MACs, SMRC, and/or UPICs. Desired experience performing medical review for fraud, waste, and abuse (FWA) investigations. Knowledgeable of ICD-9-CM, ICD-10, CPT-4 and HCPCS coding. One year or more of utilizing InterQual and/or reputed company guidelines against inpatient services experience is preferred Apply To This Job