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RN Medical Claims Reviewer
A company is looking for a Medical Claims Reviewer to conduct medical reviews for Durable Medical Equipment claims. Key Responsibilities: Conduct medical claim reviews for complex services, pre-authorizations, appeals, and coding accuracy Use established clinical guidelines to make coverage and reimbursement determinations Document medical rationale for claim approvals or denials and provide education to teams regarding medical reviews Qualifications - What You Need to Succeed: Active, unrestricted RN license in the U.S. or compact multistate RN license Associate's degree in a related field or graduate of an Accredited School of Nursing Minimum two years of clinical nursing experience Proficiency in Microsoft Office and ability to work with multiple software programs Medicare Part B and DME claims experience preferred
A company is looking for a Medical Claims Reviewer to conduct medical reviews for Durable Medical Equipment claims.
Key Responsibilities:
Conduct medical claim reviews for complex services, pre-authorizations, appeals, and coding accuracy
Use established clinical guidelines to make coverage and reimbursement determinations
Document medical rationale for claim approvals or denials and provide education to teams regarding medical reviews
Qualifications - What You Need to Succeed:
Active, unrestricted RN license in the U.S. or compact multistate RN license
Associate's degree in a related field or graduate of an Accredited School of Nursing
Minimum two years of clinical nursing experience
Proficiency in Microsoft Office and ability to work with multiple software programs
Medicare Part B and DME claims experience preferred