Medical Reviewer III – Medicare, DRG

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

📋 Description

• Conduct comprehensive medical record and claims reviews for DRG claims related to Medicare.

• Perform detailed claims analysis using ICD-10-CM, CPT-4, and HCPCS Level II coding standards.

• Leverage electronic health information imaging and document medical review outcomes via an electronic database module.

• Utilize both internet and intranet resources for the verification of policies.

• Oversee the review process for Medicare DRG claims.

• Achieve quality and production benchmarks.

⛳️ Requirements

• Must possess a Registered Nurse qualification (Bachelor's degree, Associate's degree, or Diploma in Nursing).

• A minimum of four (4) years of experience in claims (including billing, reviewing, or processing Durable Medical Equipment).

• At least three (3) years of clinical experience as a Registered Nurse.

• A minimum of two (2) years of experience with federal and local policy applications relevant to Medicare insurance.

• Current Registered Nurse licensure in one or more U.S. states or D.C.

• Ability to maintain the confidentiality of sensitive materials.

• Must have no pending or past adverse actions against him/her from any State or Federal licensing board or program, and must not have any conflict of interest (COI).

🏝️ Benefits

• Recognized as a Military Friendly Employer for 2024.

• Dedicated to hiring and supporting active-duty and veteran employees.