Claims Reviewer - Physician Licensed

Job Summary

A company is looking for a Claims Reviewer to conduct reviews of billed procedure codes in ER claims for clinical appropriateness.

Key Responsibilities

• Conduct reviews of billed procedure codes in ER claims
• Assess clinical appropriateness of charged codes
• Utilize clinical electronic medical record systems for reviews

Required Qualifications

• Active, unrestricted physician license in the US
• 3-5 years of experience reviewing claims for clinical appropriateness
• 5 years of experience with professional services CPT code level requirements
• 5 years of experience working with clinical electronic medical record systems
• 5 years of experience with Microsoft products (Excel, Word, PowerPoint)