Medical Reviewer III, Medicare Part A

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

📋 Description

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

• Undertake various projects or responsibilities assigned in the role of Medical Review Specialist.

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

• Leverage electronic health information imaging and enter medical review decisions into the electronic database module.

• Utilize the Microsoft Office suite and other software templates for claims review input.

• Exercise clinical judgment based on professional experience when necessary.

• Oversee the review process for Medicare Part A claims.

• Achieve quality and production benchmarks.

⛳️ Requirements

• Must possess a Registered Nurse qualification through either a Bachelor's degree, Associate's degree, or a Nursing Diploma.

• Minimum of four (4) years of relevant experience.

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

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

• Ability to maintain the confidentiality of sensitive information.

• Must not have any pending or completed adverse actions against them by any State or Federal licensing board or program, and must have no conflict of interest (COI).

🏝️ Benefits

• Health insurance

• 401(k) matching

• Flexible work hours

• Paid time off