Medical Reviewer III, Medicare Part A
Job Description:
- Perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare PART A.
- Perform projects or duties as assigned as a Medical Review Specialist.
- Conduct in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles.
- Utilize electronic health information imaging and input medical review decisions by electronic database module.
- Make clinical judgment decisions based on clinical experience when applicable.
- Responsible for review of Medicare Part A claims.
Requirements:
- Must be a Registered Nurse obtained by either a Bachelor's degree – OR - Associate's degree – OR - Diploma in Nursing.
- At least four (4) years related experience.
- At least three (3) years 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 keep sensitive and confidential material private.
- Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI).
Benefits:
- Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs.
- Flexible work arrangements
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