Medical Reviewer III – Medicare/DME

📋 Description

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

• Play a vital role in fulfilling our commitment to delivering exceptional services to our clients.

• 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 through an electronic database module.

• Oversee the examination of Medicare DME claims.

• Achieve established quality and production targets.

⛳️ Requirements

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

• A minimum of four (4) years of claims experience in billing, reviewing, or processing DME.

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

• A minimum of two (2) years applying federal and local policies related to Medicare insurance procedures.

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

• Capability to maintain the confidentiality of sensitive and private information.

• No pending or previously taken adverse actions against him/her by any State or Federal licensing board.

🏝️ Benefits

• Empower AI is honored to be recognized as a 2024 Military Friendly Employer by Viqtory.

• In-depth medical record and claims review processes.

• Ensure adherence to quality management systems and ISO standards.