Medical Reviewer
New
B
Broadway VenturesHome health review
Location: United StatesContractJunior
Salary28.85 - 31.25 USD per hour
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Job Details
- Experience
- A minimum of 2 years of clinical experience, along with at least 2 years of experience in home health, quality assurance, or utilization review.
- Required Skills
- Quality Assurance
Requirements
- Possess an active, unrestricted RN license in your state of residence.
- Have at least 2 years of clinical experience.
- Have at least 2 years of experience in home health, quality assurance, or utilization review.
- Home health experience, including OASIS or Medicare Conditions of Participation, is preferred.
- Prior involvement with MAC, RCD, or CMS program integrity is preferred.
- Proficiency in ICD coding is preferred.
Responsibilities
- Review home health pre-claim review (PCR) packages for compliance with Medicare coverage, coding, and payment criteria.
- Document affirmation or non-affirmation outcomes and clinical rationale in the designated case management system.
- Complete reviews within 7 business days.
- Engage with providers, as authorized, to request or clarify documentation.
- Escalate provider concerns or suspected fraud according to program procedures.
- Maintain a 98% accuracy standard.
- Complete required training, quality assurance reviews, and inter-rater reliability sessions.
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