Remote Clinical Fraud Waste Abuse Subject Matter Expert Nurse in Alexandria

Location: Virginia

Compensation: To Be Discussed

Staff Reviewed: Fri, Oct 16, 2020

This job expires in 18 days

Remote Level: 100% Remote

Employer Type: Employer

Career Level: Experienced

Education Level: Bachelors

Job Summary

A management consulting company has a current position open for a Remote Clinical Fraud Waste Abuse Subject Matter Expert Nurse in Alexandria.

Core Responsibilities of this position include:

  • Supporting FWA study development and execution activities in multi-payer type environments
  • Educating various audiences about how claims data are reported, processed, and ultimately inform study results

Applicants must meet the following qualifications:

  • Experience with Billing, coding, and medical record documentation processes in clinical settings
  • Experience with Claims processing, including adjudication, payment, adjustment, demand and recovery
  • Experience with Medical review, including determinations, authorizations, peer review, utilization review, and appeals
  • Expertise in medical terminology and all healthcare coding (e.g., ICD-10, CPT, HCPCS)
  • Strong knowledge of health care benefit structure and claim processing systems