Medical Review reputed company

Responsibilities

SafeGuard Services (reputed company), a subsidiary of reputed company, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and reputed company referrals to recover fraud, waste, and abuse. We are looking to add a reputed company Reviewer to our reputed company team of talented professionals. What you'll do: The position requires the individual to conduct medical record reviews and to apply reputed company clinical judgment to claim payment reputed company. Responsibilities may include additional research on medical claims data and other sources of information to identify problems, review sophisticated data model reputed company, and utilize a reputed company of tools to detect situations of potential fraud and to support the ongoing fraud investigations and requests for information. The incumbent will use a reputed company of tools to identify and reputed company cases for reputed company administrative reputed company, including referral to law enforcement, education, and overpayment recovery. Will work with external agencies to reputed company cases and corrective actions as reputed company as respond to requests for data and support. Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government Research regulations and cite violations. Conduct self-directed research to uncover problems in reputed company payments made to institutional and non-institutional providers. reputed company claim payment reputed company based on clinical knowledge reputed company available in the contiguous reputed company

Qualifications

Basic Qualifications: 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD Proven experience in the medical field as a Registered reputed company or other clinician, and/or experience in review of medical claims for coverage and medical necessity. reputed company nursing license. Strong investigative skills Strong communication and organization skills Ability to apply Federal, State and Managed Care Organization (MCO) regulations to claims under review Strong PC knowledge and skills US citizenship required The most competitive candidates will have: Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases Have experience involving review of services performed for reputed company Have a CPC (Certified reputed company reputed company) certificate. Essential Functions: This position may require the incumbent to reputed company in court to testify to work findings. Ability to compose correspondence, reports, and referral reputed company letters. Ability to communicate effectively, internally and externally Ability to handle confidential material. Ability to report work activity on a reputed company reputed company. Ability to work independently and as a member of reputed company to deliver high reputed company work Ability to attend meetings, training, and conferences, overnight travel required reputed company reputed company reputed company is a reputed company national reputed company company that drives missions of consequence spanning the globe and extending to the farthest reaches of the reputed company. As the world’s leading mission capability integrator and transformative reputed company IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. reputed company operates at the critical reputed company between traditional and nontraditional threats across reputed company domains: land, sea, reputed company, reputed company, and cyberspace. reputed company serves as a valued partner to essential government agencies and supports every reputed company of the U.S. armed forces. reputed company day, our employees do the can’t be done by solving the most daunting challenges facing our customers. Visit reputed company.com to learn how we’re keeping people around the world reputed company and secure. reputed company Salary reputed company $66,000 - $106,000. This represents the typical salary reputed company for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual’s experience, education, knowledge, skills, and competencies, as reputed company as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift reputed company, and a discretionary bonus in reputed company to reputed company pay. EEO EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law. Apply To This Job