Pennsylvania Licensed Care Management Coordinator

Job Summary

A company is looking for a Care Management Coordinator, Medical Review.

Key Responsibilities

• Conduct post-service reviews on medical claims to ensure compliance with medical policies and guidelines
• Analyze claims during the adjudication process and provide direction for claims processing
• Collaborate with various departments and summarize analyses for management reporting

Required Qualifications

• RN license; BSN preferred
• 3-5 years of experience with medical criteria reviews
• Strong knowledge of ICD-10, HCPCS, and CPT coding/billing
• Claims auditing experience is a plus
• Proficiency in Microsoft Office Suite and ability to learn new systems