Medical Review Nurse II - SNF/MDS Auditor
M
MachinifyHealthcare Intelligence
Remote - USFull-TimeMiddle
Salary85,000 - 100,000 USD per year
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Job Details
- Experience
- Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting.
- Required Skills
- Microsoft Office
Requirements
- Active unrestricted RN license in good standing.
- Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting.
- Minimum of one (1) year experience with MDS/RAI process.
- Minimum of one (1) year experience performing medical records review.
- Minimum of one (1) year experience in health care claims demonstrating expertise in ICD-9/ICD-10 coding guidelines.
- Deep knowledge of HCPCS coding.
- Comprehension of the Uniform Medical Billing Form (UB-04) and application to the MDS billing process.
- Knowledge of PDPM payment Items contributing to payment methodologies.
- Proficiency in Microsoft Office products including Word, Excel, and PowerPoint.
- Ability to manage multiple tasks including desk audits and claims review independently.
- Must not be currently sanctioned or excluded from the Medicare program by the OIG.
Responsibilities
- Audit claims for medically appropriate services in skilled nursing facility settings applying medical review guidelines and policies.
- Document all findings referencing 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 vulnerabilities and cases subject to potential abuse.
- Partner with clients and colleagues to improve medical policies, provider education, and system edits.
- Participate in establishing edit parameters, new issue packets, and development of Medical Review Guidelines.
- Assist with QA functions and training team members.
- Interface with and support the Medical Director and cross train in all clinical areas.
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