Medical Reviewer III, Medicare Part A

📋 Description

• Conduct comprehensive reviews of Medicare medical records and claims to determine payment eligibility for Medicare PART A.

• Undertake various projects or responsibilities assigned as a Medical Review Specialist.

• Play a vital role in fulfilling our mission of delivering outstanding services to our clients.

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

• Employ electronic health information imaging and document medical review outcomes through an electronic database module.

• Use the Microsoft Office suite and various software templates for claims review input.

• Make clinical judgment decisions based on relevant clinical experience when appropriate.

• Responsible for the evaluation of Medicare Part A claims.

⛳️ Requirements

• Must hold a Registered Nurse designation obtained through either a Bachelor's degree, an Associate's degree, or a Diploma in Nursing.

• A minimum of four (4) years of relevant experience is required.

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

• Current Registered Nurse licensure in one or more of the 50 states or D.C. is required.

• Ability to maintain the privacy of sensitive and confidential information.

• Must have no pending or past adverse actions against him/her from any State or Federal licensing board or program and must have no conflict of interest (COI).

🏝️ Benefits

• Empower AI is honored to be acknowledged as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs.

• This position offers a casual work environment.