Telecommute Healthcare Fraud Waste and Abuse Clinical Reviewer

Job ID: Available for Members

Location: Nationwide

Compensation: To Be Discussed

Staff Reviewed: Fri, Mar 22, 2019

This job expires in 1 days

Job Category: Healthcare, Medical Coding, Quality Assurance

Telecommute Level: Occasionally

Travel Requirements: Field Travel Required, Some Travel

Employer Type: Employer

Career Level: Experienced

Job Summary

A healthcare billing services company has an open position for a Telecommute Healthcare Fraud Waste and Abuse Clinical Reviewer.

Candidates will be responsible for the following:

  • Identifing aberrancies and trends related to claim submissions by providers, facilities and pharmacies
  • Compiling and preparing findings identifying key areas of concern
  • Using knowledge of healthcare coding, conduct reviews of medical records and claims

Applicants must meet the following qualifications:

  • Knowledge of federal and state guidelines as well as ICD, CPT, HCPCS, DRG, and REV codes
  • Registered Nurse with a current, valid unrestricted license
  • Minimum of 3 years claims knowledge (billing or reviewing)
  • Minimum of 3 years clinical experience as a registered nurse
  • Above average proficiency with MS Word and Excel
  • Ability to quickly adapt to different anti-fraud technology solutions