Overview Employer Industry: Government Technology Solutions
Why consider this job opportunity Opportunity for part-time work with flexible scheduling
Recognized as a 2024 Military Friendly Employer, supporting active-duty and veteran employees
Work with a leading organization dedicated to meaningful transformation in government
Contribute to efforts in enhancing the efficiency and integrity of Medicare and Medicaid systems
Engage in a collaborative and supportive work environment
Chance to utilize your clinical expertise in a meaningful way while ensuring compliance with regulations
What to Expect (Job Responsibilities) Review and analyze Medicare claims to make payment determinations based on coding and utilization
Conduct in-depth claims analysis to identify potential fraudulent billing practices
Complete summary reports detailing claim determinations and clinical observations
Maintain compliance with Medicare and Department of Justice guidelines and regulations
Participate in Quality Assurance monitoring and adhere to departmental policies
What is Required (Qualifications) Registered Nurse (RN) with a Bachelor’s, Associate’s degree, or diploma
Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
At least 10 years of clinical experience, with a minimum of 7 years in claims knowledge
Excellent oral and written communication skills, along with strong organization and time management skills
Medical review experience and ability to maintain confidentiality of sensitive information
How to Stand Out (Preferred Qualifications) Previous experience in fraud review or investigation
Familiarity with Microsoft Excel, Word, Adobe PDFs, and various internet applications
Ability to analyze data and perform in-depth research
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.