Job Description
Are you a dedicated and experienced Registered Nurse with a passion for ensuring the integrity and accuracy of medical claims? We're seeking a skilled Medical Review Nurse (MRN) to join our dynamic Federal Team and play a crucial role in supporting our medical claim and review operations. If you're looking for a challenging and rewarding opportunity to utilize your clinical expertise and contribute to a vital public service, we encourage you to apply!
What You'll Do:
As a Medical Review Nurse, you'll be at the forefront of ensuring that medical services and items billed are reasonable, necessary, and compliant with national and local policies, accepted billing and coding practices, and established standards of medical care. Your responsibilities will include:
Comprehensive Medical Record and Claims Review: Dive into complex medical records and billing/claims cases and projects, meticulously evaluating them to ensure accuracy and compliance.
Coding Practice Evaluation: Analyze and assess medical coding practices, ensuring they align with established guidelines and standards.
Application of Clinical Guidelines: Utilize your clinical expertise and knowledge of coverage and medical criteria to make informed decisions on case reviews and projects.
Stakeholder Collaboration: Engage with various stakeholders to facilitate thorough and effective case reviews, fostering clear communication and collaboration.
Documentation and Communication: Prepare detailed inquiry letters, investigation finding letters, and comprehensive case summaries, ensuring clear and concise documentation.
Fraud Detection and Referral: Identify and refer potential fraud leads to the appropriate resources, contributing to the prevention of healthcare fraud, waste, and abuse.
Data Management and Reporting: Accurately enter, track, and report case-specific and other required data, ensuring data integrity and compliance.
Program Support: Perform other related program duties as assigned, contributing to the overall success of our medical review operations.
What We're Looking For:
Active RN License: A current, valid, and unrestricted Registered Nurse (RN) license is essential.
Medical Review Expertise: A minimum of 3-5 years of recent experience in medical review, claims review, or coding review for payment accuracy is required. Experience with CERT (Comprehensive Error Rate Testing) is highly valued.
Medicare Claims Experience: Previous experience reviewing Medicare Part A and B claims, including prior authorization or appeals, using established criteria to make medical review determinations.
Analytical and Research Skills: Proven ability to analyze complex information, conduct thorough research, and make sound judgments.
Communication Skills: Excellent written and verbal communication skills, enabling you to effectively interact with stakeholders and prepare clear and concise documentation.
Technical Proficiency: Experience working with multiple research/processing systems and proficiency in MS Word, Excel, and PowerPoint.
Background Check and Drug Screening: Ability to successfully pass required background checks and drug screenings.
Integrity: No conflicts of interest related to other active employment (full or part-time).
Fraud, Waste, and Abuse Awareness: Proven track record in Fraud, Waste, and Abuse related activities.
Independent worker: Ability to work well independently.
What You'll Gain:
A rewarding career contributing to the integrity of federal healthcare programs.
The opportunity to utilize and expand your clinical and analytical skills.
A collaborative and supportive team environment.
Competitive salary (negotiable).
Full-time employment.
Work authorization in the United states is required.
Required License:
Registered Nurse (RN) with no sanctions.
Job Type:
Full-time.
Salary:
Negotiable.
Work Authorization:
United States (Required).
Additional Requirements:
This job requires you to pass a background check.
This job requires a drug screening.
We are committed to providing equal opportunities and fostering a diverse and inclusive workplace. If you are a qualified and passionate RN looking to make a meaningful impact, we encourage you to apply!
Employment Type: Full-Time
Salary: $ 34.00 Per Hour
Job Tags
Hourly pay, Full time, Part time, Local area,