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