Job Summary
A company that provides technology-enabled recovery and related analytics services is searching for a person to fill their position for a Remote Medical Review Nurse.
Candidates will be responsible for the following:
- Auditing claims for medically appropriate services provided in both inpatient and outpatient settings
- Applying appropriate medical review guidelines, policies and rules
- Generating letters articulating audit findings
Qualifications for this position include:
- 3 years diversified nursing experience providing direct care in an inpatient or outpatient setting.
- 1 or more years experience performing medical records review
- 1 or more years experience in health care claims
- Experience with utilization management systems or clinical decision making tools
- Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding
- Knowledge of insurance programs program, particularly the coverage and payment rules
