Remote Medical Review RN, Medicare

Job Overview

  • Specialty License RN
  • State License(s) Nationwide

RESPONSIBILITIES

  • Review medical claim and assess patient’s records
  • Ensures compliance with state and federal regulatory requirements
  • Researches to determine appropriate payment

BASIC QUALIFICATIONS

  • Must have an active RN license, preferably in a resident state that holds compact license
  • Previous experience as a Medicare Part A and/or Part B Medical Review Nurse working for a Medicare Administrative Contractor (MAC)
  • Previous experience as a Registered Nurse in a clinical setting
  • Must have working knowledge of HCPCS, CPT and ICD-9 and/or ICD-10 codes, as well as CMS guidelines, MCS and FISS.
  • Requires excellent verbal and written communication skills
  • Excellent analytical and problem-solving skills with the ability to make independent decisions
  • Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
  • Ability to remain focused and productive each day though tasks may be repetitive

PREFERRED QUALIFICATIONS

  • Previous successful work at home experience

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