Medical Reviewer III – Medicare, DRG
Job Description:
- Perform Medicare comprehensive medical record and claims review for DRG claims
- 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
- Utilize internet and intranet sources for policy verification
- Responsible for review of Medicare DRG claims
- Meet quality and production standards
Requirements:
- Must be a Registered Nurse (Bachelor's degree, Associate's degree, or Diploma in Nursing)
- At least four (4) years claims knowledge (billing, reviewing, or processing of Durable Medical Equipment)
- At least three (3) years clinical experience as a Registered Nurse
- Minimum two (2) years federal and local policy applications in relation to Medicare insurance
- 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:
- 2024 Military Friendly Employer recognition
- Commitment to hiring and supporting active-duty and veteran employees