Medical Review Examiner, RN - Part A at Fargo

Job Description

Medical Review Examiner, RN - Part APosition Objective

The purpose of this job is to reduce medical necessity claim errors through complex medical review, requiring the analysis of available patient medical information, applying Medicare guidelines and then educate and train providers on the accurate submission of covered medically necessary services.

Knowledge

• Medical policies and procedures;
• Nursing theory and practices;
• Computer literate;
• Will learn: -Medicare rules and regulations/guidelines; -Medicare insurance claims processing;
• CPT 4 and ICD 10 Medical diagnosis coding;

Abilities

• Research, analyze, and interpret detailed medical records and policies, benefits, and established guidelines;
• Ability to make decisions/problem solving skills;
• Proven oral and written communication skills;
• Organize and prioritize workload in order to meet standards and deadlines;
• Self-starter goal oriented individual;
• Work independently and in a team environment;
• Operate basic office equipment (e.g. keyboard, fax, copy, telephone, etc.);
• Ability to travel

Job Requirements

Medical Review Examiner, RN - Part AEducation and/or Experience

• An active Registered Nurse/RN license in the state the reviewer is working from and 2+ years clinical, hospital or nursing home experience (exposure to Medicare claims processing a plus).

Country: USA, State: North Dakota, City: Fargo, Company: Noridian Healthcare Solutions LLC.