Medical Review II (Medicare)
B
Broadway VenturesMedicare claims review
Location: Remote; Candidates must live in and work from an eligible U.S. state when they are hired and for as long as they are employed.Full-TimeMiddle
Salary62,000 - 65,000 USD per year
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Job Details
- Experience
- 2 years clinical experience.
- Required Skills
- Microsoft OfficeCustomer serviceAnalytical thinking
Requirements
- Have an associate degree in nursing or graduate from an accredited school of nursing.
- Have at least 2 years of clinical experience.
- Hold active RN licensure in the state hired or an active compact multistate RN license as defined by the Nurse Licensure Compact.
- Have working knowledge of word processing software and Microsoft Office.
- Demonstrate the ability to work independently, prioritize effectively, and make sound decisions.
- Demonstrate good judgment.
- Have customer service and organizational skills.
- Demonstrate oral and written communication skills.
- Have analytical or critical thinking skills.
- Handle confidential or sensitive information with discretion.
Responsibilities
- Perform complex medical review of Medicare claims for Inpatient Rehabilitation Facility services.
- Conduct pre-claim review determinations.
- Evaluate Additional Documentation Request responses.
- Communicate determinations directly to providers.
- Meet strict contractual turnaround requirements in a production-driven role.
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