Medical Reviewer III – Medicare DME Claims
Empower AI
full-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- Perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment (DME).
- Perform projects or duties as assigned as a Medical Review Specialist.
- Conduct in-depth claims analysis utilizing ICD-10-CM, AMA-CPT, and HCPCS Level II coding principles.
- Utilize electronic health information imaging and input medical review decisions by electronic database module.
- Ensure departmental compliance with quality management system and ISO requirements.
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 of Durable Medical Equipment.
- At least three (3) years clinical experience as a Registered Nurse.
- Minimum four (4) 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 by Viqtory, the publisher of G.I. Jobs.
- Comprehensive medical record and claims review for Medicare Durable Medical Equipment (DME).
- Serve as a critical component in meeting our mission of providing excellent services to our clients.
- Opportunity to be at the forefront of activities related to implementing healthcare reform on a national level.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
ICD-10-CMAMA-CPTHCPCS Level II codingclaims analysismedical record reviewpayment determinationsDurable Medical Equipment (DME)quality management systemISO requirementsclinical experience
Soft Skills
confidentialityattention to detailanalytical skillscommunication skillsorganizational skills
Certifications
Registered NurseBachelor's degree in NursingAssociate's degree in NursingDiploma in Nursing