Empower AI

Medical Reviewer

• 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.

Medical Reviewer III, Medicare Part A