North Carolina Licensed Medical Review Analyst

A company is looking for a Medical Review Analyst to evaluate medical necessity and reimbursement for complex claims. Key Responsibilities Determine medical necessity, benefit eligibility, and reimbursement allowances for complex claims using clinical expertise and various resources Ensure compliance with regulatory and accrediting body requirements during reviews and determinations Document and report inappropriate billing patterns and conduct post adjudication reviews of claims Required Qualifications RN, PA, or NP with a minimum of 3 years of clinical experience, preferably in diverse clinical settings LPN with a minimum of 5 years of clinical nursing experience in varied clinical environments Must hold and maintain a valid North Carolina clinical license

Apr 21, 2025 - 14:22

A company is looking for a Medical Review Analyst to evaluate medical necessity and reimbursement for complex claims. Key Responsibilities Determine medical necessity, benefit eligibility, and reimbursement allowances for complex claims using clinical expertise and various resources Ensure compliance with regulatory and accrediting body requirements during reviews and determinations Document and report inappropriate billing patterns and conduct post adjudication reviews of claims Required Qualifications RN, PA, or NP with a minimum of 3 years of clinical experience, preferably in diverse clinical settings LPN with a minimum of 5 years of clinical nursing experience in varied clinical environments Must hold and maintain a valid North Carolina clinical license