Medical Claims Reviewer, 6 Month Contract

This is a fully remote position, open to applicants in United States.

📋 Description

• Perform reviews of ESRD medical records by comparing documentation with EQRS and NHSN to assess accuracy and timely submissions.

• Identify and categorize discrepancies according to the type and severity of errors, which may include absent data, incorrect values, and data entered in inappropriate fields.

• Engage in quality control initiatives to support the goals of both the corporate entity and team.

• Aid with special projects or tasks as delegated by management.

⛳️ Requirements

• Possess an active, unrestricted RN license in the United States and in the state of employment OR hold an active compact multistate unrestricted RN license.

• Hold an Associate Degree in Nursing OR be a graduate of an accredited School of Nursing.

• Have two years of clinical experience along with two years of experience in utilization/medical review, quality assurance, or end-stage renal disease/dialysis.

• Demonstrate a strong clinical background in dialysis, managed care, home health, rehabilitation, and/or medical-surgical environments.

• Possess knowledge of specific criteria/protocol sets and the capability to apply them effectively.

• Exhibit proficiency in word processing software and Microsoft Office applications.

• Exhibit the ability to work independently, prioritize tasks, and make informed decisions.

• Display excellent customer service, communication, organizational, and critical thinking abilities.

• Handle confidential information with appropriate discretion.

• Be adept with computers, including the ability to utilize multiple screens and applications at once.

• Have access to high-speed internet (non-satellite) and a private, secure home office.

• Undergo a background check and drug screening prior to starting employment; some roles may necessitate fingerprinting.

🏝️ Benefits

• 401(k) plan with company matching contributions.

• Paid Time Off (PTO) that increases with tenure.

• Comprehensive health, vision, and dental insurance.

• Company-sponsored Life Insurance and optional Voluntary Life Insurance.

• Short-term and long-term disability coverage.

• Potential for contract extension or conversion.