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Medical Reviewer III, Medicare Part A
Empower AIMedical Reviewer III at Empower AI performing Medicare Part A claims reviews. Contributing to healthcare reform by ensuring compliance and quality management in medical record analysis.
About the role
Key responsibilities & impact- Perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare PART A.
- Perform projects or duties as assigned as a Medical Review Specialist.
- Conduct 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 Part A claims.
Requirements
What you’ll need- 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 related experience.
- At least three (3) years clinical experience as a Registered Nurse.
- 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
Comp & perks- Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs.
- Flexible work arrangements
ATS Keywords
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Hard Skills & Tools
ICD-10-CMCPT-4HCPCS Level IIclaims analysisclinical judgmentmedical record reviewpayment determinationsMedicare Part Aelectronic health informationmedical review decisions
Soft Skills
clinical experienceconfidentialityjudgmentattention to detailcommunication
Certifications
Registered NurseBachelor's degree in NursingAssociate's degree in NursingDiploma in Nursing