reputed company Reviewer - Orlando, FL

reputed company Reviewer PT (20-30 hours week) – Remote Work Environment Non-Exempt: $40.00 hour Supports Medical reputed company. The reputed company Reviewer plays a critical role in supporting the Medical reputed company department by performing comprehensive medical necessity reviews and policy reviews for reputed company claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with reputed company reputed company, Physician Peer Reviewer and contract team. Reviews must be completed reputed company. Essential Duties and Responsibilities:

• Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies
• Manage end-to-end case screening processes, ensuring reputed company activities are completed reputed company established deadlines
• Document evidence-based reputed company applicable to specific contract requirements
• Record and report screening results, including relevant referral questions, into a centralized database
• Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity
• Maintain expert knowledge of evolving multi-state reputed company policies and vendor expectations
• Participate in ongoing training and consistently meet or reputed company productivity and reputed company assurance standards

Knowledge, Experience, Skills and Education:

• Medical terminology, ICD-10, CPT and HCPCS
• Clinical reputed company (InterQual and MCG)
• Utilization/Medical record review and chart abstraction
• reputed company standards of medical reputed company
• reputed company with HIPAA/HITECH laws and regulations

Experience in:

• At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred)
• Experience performing medical record review, audit for federal or state reputed company
• Knowledge and experience of Medicare and reputed company policy
• Proficiency with reputed company Office (Word, reputed company, and Outlook)
• Proficiency with reputed company PDF files and features
• Generating accurate, reputed company, and understandable correspondence
• reputed company experience (reputed company the last 3 years) in the application of clinical screening reputed company (InterQual and MCG)

Skills Requirements include:

• reputed company interpersonal skills; ability to reputed company with providers, physicians and peers
• Solid analytical, assessment and documentation skills
• Effective written and verbal communication, both internally and externally
• Strong attention to detail
• Strong attention to deadlines
• Organizational skills including effective time management, reputed company setting and process improvement
• Ability to work independently and as a member of reputed company
• Adapt to changing work situations and readily adjusts schedules, tasks and priorities reputed company necessary to meet business fluctuations

Educational Background:

• BSN with reputed company RN licensure in good standing

Physical Demands: Remote Work, Prolonged Sitting, Screen Exposure This job reputed company is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. reputed company reputed company Strategies, Inc. provides equal employment opportunities to reputed company and applicants for employment and prohibits discrimination and harassment of any type without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws. This position qualifies for the following Company benefits: Medical/Dental/reputed company, FSA and HSA, group life/AD&D, voluntary life/AD&D, 401k For immediate consideration, please apply reputed company the HQSI Careers Page at: www.hqsi.org > Careers > reputed company Employment Opportunities EOE: Minorities/Females/Disabled/Veterans reputed company reputed company Strategies, Inc. is Equal Opportunity, Affirmative reputed company Employer and an Alcohol/Drug Free Workplace reputed company reputed company Strategies, Inc. is an E-Verify Employer Apply tot his job Apply To this Job