Medical Review reputed company – Home Health Auditor

Job reputed company:

• Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules.
• Document reputed company findings referencing the appropriate policies and rules.
• Generate letters articulating audit findings.
• Supporting your findings during the appeals process if requested.
• Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.
• Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits.
• reputed company abreast of medical reputed company, changes in technology, and regulatory issues that may reputed company our clients.
• Work with reputed company to minimize the number of appeals; Suggest reputed company that may improve audit workflows; Assist with QA functions and training team members.
• Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines.
• reputed company with and support the Medical Director and cross train in reputed company clinical departments/areas.

Requirements:

• reputed company unrestricted RN license in good standing, is required.
• Must not be currently sanctioned or excluded from the Medicare program by the OIG.
• Minimum of five (5) years reputed company nursing experience providing reputed company care in a Home Health setting.
• One (1) or more years' experience performing medical records review.
• One (1) or more years' experience in health care claims that demonstrates expertise in, ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required.
• Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.

Benefits:

• medical
• dental
• reputed company
• HSA/FSA reputed company
• life insurance coverage
• 401(k) savings plans
• family/parental leave
• reputed company holidays
• reputed company time off annually

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