Medical Claims Reviewer
New
B
Broadway VenturesHealthcare
Remote U.S. (Work from home)ContractJunior
Salary31.25 USD per hour
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Job Details
- Experience
- Two years of clinical experience plus two years of experience with utilization/medical review, quality assurance or end stage renal disease/dialysis. Three years of clinical nursing experience in End Stage Renal Disease/Dialysis is strongly preferred.
- Required Skills
- Microsoft OfficeQuality Assurance
Requirements
- Hold an active, unrestricted RN license in the United States and in the state of hire, or an active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact.
- Have an Associate Degree in Nursing or be a graduate of an accredited School of Nursing.
- Have two years of clinical experience.
- Have two years of experience with utilization/medical review, quality assurance, or end stage renal disease/dialysis.
- Have a strong clinical background in dialysis, managed care, home health, rehabilitation, and/or medical-surgical settings.
- Know specific criteria and protocol sets and be able to use them effectively.
- Be proficient with word processing software and Microsoft Office.
- Be able to work independently, prioritize tasks, and make sound decisions.
- Have customer service, communication, organizational, and critical thinking skills.
- Handle confidential information with discretion.
- Be proficient with computers, including using multiple screens and programs simultaneously.
- Three years of clinical nursing experience in End Stage Renal Disease/Dialysis is strongly preferred.
- Work Monday through Friday, 8:00 AM–4:30 PM, 40 hours per week.
- Have high-speed non-satellite internet and a private, lockable home office.
Responsibilities
- Review ESRD medical record documentation against EQRS and NHSN data to assess accuracy and timely reporting.
- Determine and classify discrepancies by type and severity, including missing data, incorrect values, and data entered in the wrong fields.
- Participate in quality control activities supporting corporate and team objectives.
- Assist with special projects and other responsibilities assigned by management.
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