Medical Reviewer III, Medicare DRG
Empower AI
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis Related Group (DRG) claims.
- Perform projects or duties as assigned as a Medical Review Specialist.
- You will serve as a critical component in meeting our mission of providing excellent services to our clients.
- Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles.
- Utilize electronic health information imaging and input medical review decisions by electronic database module.
- Make clinical judgment decisions based on clinical experience when applicable.
- Responsible for review of Medicare DRG claims and meeting quality and production standards.
Requirements
- Must be a Registered Nurse obtained by either a Bachelor's degree – OR - Associate's degree – OR - Diploma in Nursing.
- At least four (4) years claims knowledge either from billing, reviewing, or processing in an office/outpatient setting.
- At least three (3) years clinical experience as a Registered Nurse.
- Minimum two (2) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for Physician Office practices, Laboratory, and Ambulance Services.
- Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
- Ability to keep sensitive and confidential material private.
- Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI).
Benefits
- Empower AI is proud to be recognized as a 2024 Military Friendly Employer
- Employee wellness programs and support
- Opportunities for professional development
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
ICD-10-CMCPT-4HCPCS Level IIclaims analysismedical record reviewpayment determinationsclinical judgmentMedicare DRG claims reviewbillingprocessing
Soft skills
clinical experienceconfidentialityattention to detailcommunicationcritical thinkingorganizational skillsdecision makingclient serviceteam collaborationproblem solving
Certifications
Registered NurseBachelor's degree in NursingAssociate's degree in NursingDiploma in Nursing