An elevated approach to program analysis.

Medical Review Analyst, Registered Nurse

AnalystAnalystFull TimeRemoteTeam 51-200H1B No SponsorCompany Site LinkedIn

Location

Virginia

Posted

101 days ago

Salary

Not specified

Bachelor Degree5 yrs expEnglish

Job Description

• Conduct medical record reviews and apply sound clinical judgment to claim payment decisions • Additional research on medical claims data and other sources of information to identify problems • Review sophisticated data model output • Utilize a variety of tools to detect situations of potential fraud • Support ongoing fraud investigations and requests for information • Research national and local policy as well as Medicare and/or Medicaid guidelines for supporting references in review determinations • Conduct reviews under the guidance of a Medical Review Manager/supervisor

Job Requirements

Current/active RN license
5-7 years of experience in the medical field as a Registered Nurse or other clinician
Experience in review of medical claims for coverage and medical necessity
Strong investigative skills
Demonstrated proficiency in Medical Review work
Working knowledge of Medicare and Medicaid
Excellent communication skills
Demonstrated prioritization, problem solving, and organization skills
Strong computer skills including Microsoft Office proficiency
All candidates MUST pass a background check and drug screening prior to employment
Preference:**
Bachelors in of Science in Nursing (BSN)
2+ years’ clinical experience
Coding certificate
Enthusiastic individuals who can work effectively in a dynamic environment both in a team as well as independently is a must!