At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. We are seeking a registered nurse with extensive experience in clinical auditing to perform a bill review and chart validation within our Hospital Bill Review Department.
Candidate should be highly motivated, with strong clinical and auditing background. This individual must have excellent communication skills and an analytical mindset to achieve and maintain high-level performance in a fast-paced environment.
This is a fulltime position (37.5 hours per week) Monday – Friday. You’ll enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home.
If you are interested in this role with MedReview, please let us know. Here is what we are searching for:
Qualifications
Must be a registered nurse with active RN license
BSN or equivalent required
2-5 years auditing experience preferred, however will also consider Utilization Review, Managed Care, Case Management experience
2-5 years in either Medical Surgical or Critical Care experience required
Ability to use Windows PC with the ability to utilize multiple applications at the same time
Excellent computer skills
Knowledge of appeals preferred
Knowledge of CMS guidelines preferred
Responsibilities
Must be detail oriented highly organized work skills
Solid understanding of anatomy and physiology, diagnostic and surgical procedures
Demonstrates the ability to accurately interpret what is transcribed in the medical record
Writes clear, accurate and concise clinical notes in support of findings
Maintains and manages case reviews with a high emphasis on quality
Demonstrates the ability to work in a high – volume production environment
Knowledge of health insurance business, industry terminology, and regulatory guidelines
Accurately interprets Plan policies and appropriately applies to the clinical audit
Ability to communicate effectively both orally and in writing
Complete appeal reviews when needed
Demonstrates the ability to perform a level of care review utilizing Interqual guidelines
Maintain and update hospital profiles as needed
Remote Work Requirements
High speed internet (100 Mbps per person recommended) with secured WIFI.
A dedicated workspace with minimal interruptions to protect PHI and HIPAA information
Must be able to sit and use a computer keyboard for extended periods of time
Benefits and perks include:
Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents
401(k) with Employer Match - Join the team and we will invest in your future
Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays
Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered
Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional
Salary:80k-90k
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Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Internet Publishing
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