Senior Medical Reviewer
Job Description:
• Assist Medical Review Management with monitoring the medical review process
• Conduct medical record reviews for complex services
• Evaluate compliance with Medicare coverage, coding, and billing rules
• Contribute to medical review and proposal deliverables
• Participate in quality assurance activities to ensure consistency and accuracy
Requirements:
• Bachelor of Science in Nursing (BSN)
• Current, active, unencumbered Registered Nurse license in the United States
• Certified Coder credentials required
• Minimum of three (3) years of medical record review experience
• At least three (3) years of current and/or relevant clinical experience
• Two (2) years of quality assurance experience required
• Extensive knowledge of the Medicare program
• Working knowledge of CMS FFS RAC Program requirements and activities
Benefits:
• Health insurance
• 401(k) matching
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