Medical Reviewer III – Medicare DME Claims
Job Description:
• Perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment (DME).
• Perform projects or duties as assigned as a Medical Review Specialist.
• Conduct in-depth claims analysis utilizing ICD-10-CM, AMA-CPT, and HCPCS Level II coding principles.
• Utilize electronic health information imaging and input medical review decisions by electronic database module.
• Ensure departmental compliance with quality management system and ISO requirements.
Requirements:
• Must be a Registered Nurse obtained by either a Bachelor's degree – OR - Associate's degree – OR - Diploma in Nursing.
• At least four (4) years claims knowledge either from billing, reviewing, or processing of Durable Medical Equipment.
• At least three (3) years clinical experience as a Registered Nurse.
• Minimum four (4) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for Physician Office practices, Laboratory, and Ambulance Services.
• Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
• Ability to keep sensitive and confidential material private.
• Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI).
Benefits:
• Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs.
• Comprehensive medical record and claims review for Medicare Durable Medical Equipment (DME).
• Serve as a critical component in meeting our mission of providing excellent services to our clients.
• Opportunity to be at the forefront of activities related to implementing healthcare reform on a national level.
• Perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment (DME).
• Perform projects or duties as assigned as a Medical Review Specialist.
• Conduct in-depth claims analysis utilizing ICD-10-CM, AMA-CPT, and HCPCS Level II coding principles.
• Utilize electronic health information imaging and input medical review decisions by electronic database module.
• Ensure departmental compliance with quality management system and ISO requirements.
Requirements:
• Must be a Registered Nurse obtained by either a Bachelor's degree – OR - Associate's degree – OR - Diploma in Nursing.
• At least four (4) years claims knowledge either from billing, reviewing, or processing of Durable Medical Equipment.
• At least three (3) years clinical experience as a Registered Nurse.
• Minimum four (4) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for Physician Office practices, Laboratory, and Ambulance Services.
• Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
• Ability to keep sensitive and confidential material private.
• Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI).
Benefits:
• Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs.
• Comprehensive medical record and claims review for Medicare Durable Medical Equipment (DME).
• Serve as a critical component in meeting our mission of providing excellent services to our clients.
• Opportunity to be at the forefront of activities related to implementing healthcare reform on a national level.