Medical Review Nurse – SNF/MDS Auditor, Government-CMS RAC
BASF
full-time
Posted on:
Location Type: Remote
Location: Florida • United States
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Salary
💰 $84,000 - $100,000 per year
About the role
- Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules.
- Document all 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.
- Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients.
- Work with the team to minimize the number of appeals; Suggest ideas 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.
- Interface with and support the Medical Director and cross train in all clinical departments/areas.
- Other duties as required to meet business needs.
Requirements
- Active 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 diversified nursing experience providing direct care in an inpatient or outpatient 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
- vision
- HSA/FSA options
- life insurance coverage
- 401(k) savings plans
- family/parental leave
- paid holidays
- paid time off annually
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
ICD-9 codingICD-10 codingHCPCS codingCPT codingDRG codingmedical billingutilization reviewmedical records reviewauditingquality assurance
Soft Skills
collaborationcommunicationproblem-solvingcritical thinkingattention to detailorganizational skillstrainingsupportarticulation of findingssuggesting improvements
Certifications
Active RN license