Medical Review Nurse II - SNF/MDS Auditor
New
M
MachinifyHealthcare intelligence
Remote - USFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- Minimum of five (5) years diversified nursing experience
- Required Skills
- Microsoft Office
Requirements
- Active unrestricted RN license in good standing
- Not currently sanctioned or excluded from the Medicare program by the OIG
- Minimum of five (5) years diversified nursing experience in inpatient or outpatient setting
- One (1) or more years experience with MDS/RAI process
- One (1) or more years experience performing medical records review
- One (1) or more years experience in health care claims demonstrating ICD-9/ICD-10 coding expertise
- Comprehension of the Uniform Medical Billing Form (UB-04) and MDS billing process
- Proficiency in Microsoft Office (Word, Excel, PPT)
- Ability to manage multiple assignments and prioritize workload
Responsibilities
- Auditing claims for medically appropriate services provided in skilled nursing facility settings
- Document all findings referencing the appropriate policies and rules
- Generate letters articulating audit findings
- Support audit findings during the appeals process if requested
- Work collaboratively with the audit team to identify potential abuse
- Work in partnership with clients and contractors on medical policies and provider education
- Keep abreast of medical practice and regulatory issues
- Assist with QA functions and training team members
- Participate in establishing edit parameters and Medical Review Guidelines
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