Remote Medical Reviewer III

Job ID: Available for Members

Location: Nationwide

Compensation: To Be Discussed

Staff Reviewed: Thu, Nov 14, 2019

This job expires in 23 days

Job Category: Healthcare, Investigations, Nursing

Telecommute Level: Occasionally

Travel Requirements: Field Travel Required, Some Travel

Employment Status: Permanent

Employer Type: Employer

Career Level: Experienced

Education Level: Some College

Additional Information: Benefits Available

Job Summary

A full-service investigations company has a current position open for a Remote Medical Reviewer III.

Must be able to:

  • Review information contained in Standard Claims Processing System files
  • Determine provider billing patterns
  • Detect potentially fraudulent or abusive billing practices or vulnerabilities in payment policies

Qualifications Include:

  • Valid driver' license to perform onsite audits
  • Graduate from an accredited school of nursing
  • Active license as a Registered Nurse (RN)
  • 4+ years utilization/quality assurance review and ICD-9/10-CM/CPT-4 coding experience
  • 4+ years of experience in coding and abstracting
  • Working knowledge of Diagnosis Related Groups (DRGs) and Prospective Payment Systems