Medical Review Nurse Analyst - RN

Job Summary

A company is looking for a Medical Review Nurse Analyst RN to review medical documentation submitted to Medicare.

Key Responsibilities

• Review claims to ensure services are medically necessary and correctly coded based on Medicare guidelines
• Educate providers on billing, documentation requirements, and the Targeted Probe and Educate program
• Monitor provider progress and deliver ongoing education to ensure correct reimbursement

Required Qualifications

• Associate or Bachelor Degree in Nursing
• Active RN license applicable to the state of practice
• 4 or more years of experience in clinical nursing (preferred)
• 1 or more years of medical claims review experience (preferred)
• Experience with Medicare contracts and government Medicare principles (preferred)