Medical Review Specialist III (Medicare Part A- SNF) – Remote Jobs

Job Name: Medical Review Specialist III (Medicare Part A- SNF)
Name of the Company: Empower AI
Location: US National
Salary range: Not mentioned

Position Description

Empower AI is looking for an experienced and knowledgeable Medical Review Specialist III to perform comprehensive medical record and claims review for Medicare coverage for Skilled Nursing Facilities (SNF), Inpatient, Outpatient Facilities and Services, and Diangostic Related Group (DRG). In this role, you will play a critical component in meeting our mission of providing excellent services to our clients. You will utilize electronic health information imaging to make clinical judgement based on clinical experience and relevant medical practices, maintain quality compliance, and ISO requirements.

Responsibilities

– Conduct comprehensive medical record and claims review to make payment determinations for Medicare Part A SNF, DRG, and Outpatient Facilities and Services
– Conduct in-depth claims analysis using ICD-10-CM, CPT-4, and HCPCS Level II coding principles
– Utilize electronic health information to make clinical judgment decisions, maintain quality compliance, and ISO requirements
– Meet quality and production standards
– Ensure departmental compliance with quality management system and ISO requirements
– Perform other projects or duties as assigned by the Medical Review Lead Specialist

Qualifications

– Must be a Registered Nurse with at least a Bachelor’s degree, Associate’s degree or Diploma in Nursing
– At least two (2) years of claims knowledge from either billing, reviewing, or processing in an SNF, Inpatient, or outpatient/office setting
– At least four (4) years of clinical experience as a Registered Nurse
– Minimum two (2) years of federal and local policy applications in relation to Medicare insurance procedures for medical necessity for SNF, Inpatient, and/or Outpatient Facilities and 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
– No adverse actions pending or taken against the applicant by the State or Federal licensing board or program, and must have no conflict of interest (COI)
– Possess and maintain a valid state driver’s license for the state of residence

Physical Requirements:
– Must be able to sit or stand for long periods
– Must be able to ambulate throughout an office and between several buildings
– Must be able to stoop, kneel, crouch, or crawl as required

Empower AI is proud to be an equal opportunity employer. They follow affirmative action in keeping with applicable federal, state, and local laws and regulations.