The Medical Review reviews the audit of the nurse medical claims. As an MR Nurse, you will join the team of experienced medical auditors and coders for retrospective and prepaid audits on government claims, and commercial drinkers will work in a fast, dynamic and dynamic environment and will be part of a multi-location team Will be
Nursing Recruitment Medical Review Nurse ,In this role, you will be responsible for:
Auditing claims for medical services available in both the inpatient and outpatient procedures Apply appropriate medical review guidelines, policies and rules, by referring audiovisual findings to contextualizing appropriate policies and rules, and rationalizing audit findings. Generate request to support your findings during the appeals process To work together with the audit team to obtain and obtain approval for cases under potential vulnerabilities and / or possible abuse, our customers, CMD colleagues, and to improve medical policies, provider education and system improvement Work in partnership with other contractors. Medical practice, changes in technology and regulatory issues affecting our clients. Work with the team to reduce the number of appeals Suggest suggestions. Audit work flow may improve if necessary, with QA functions. Participate in editing partispip if necessary, members of the training team in the development of e-Medical Review Guidelines To assist with the area and meet the business requirements of the interface and other requirements to support the medical director of Cross train all clinical departments / areas
Essential skills and knowledge:
Nursing Recruitment Medical Review Nurse
Empowerment experience for the experience reviewing the use of insurance for the insurance company, Tricker, MAC or similar organizations Experience in home health and skilled nursing facility Medical review utility management system or medical decision-making tools like Medical Coverage Guidelines (MCG) or Interqual experience with . Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding. Knowledge of the insurance program program, especially the coverage and payment rules. Ability to maintain high quality work while meeting harsh time limits. Excellent written and verbal communication skills. At present, the OIG has not been approved or removed from the Medicare program, in good condition, the active unrestricted RN license
The ability to manage many tasks, including desk audit and review of the claims, should be able to use standard office computer technology (such as email telegraph, copier, etc.) and review the issues and review the documents. Experience the use of the case management system / equipment. Many assignments should be able to handle effectively, preparing documents for conclusions and / or documentation, systematically and prioritizing workload should work independently and with team members effectively.
• Sit / stand / walk / 8-10 hours / day
• Elevate / take / push / pull more than 10 lbs below
• keying frequency, handling, reaching, manipulation
Education and Experience:
The minimum three years of the Home Health and Skilled Nursing experience provide direct care in an inpatient or outpatient setting.
One or more years of experience in reviewing medical records
One or more years of experience in health care claims which show expertise in ICD-9 / ICD-10 coding, HCPS / CPT, HIPPS coding and medical billing experience for an insurance company or hospital.
-Submit textual inquiry and pass.
– Be able to investigate a criminal background; No crimes or specific abusers should be
-Contact and pass medication screen
Performant is a government contractor For this situation, some client assignments require successful results and successful results of acceptance in full employment with additional background and / or company.