NCI
Medical Review Specialist III (All Medicare claim types)
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Job Description
- Req#: 8378
Employer Industry: Government Services (Healthcare)
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Recognized as a 2024 Military Friendly Employer, supporting active-duty and veteran employees
- Work in a dynamic environment focused on healthcare reform at a national level
- Engage in meaningful work that directly impacts Medicare claims and services
- Collaborative team atmosphere with a commitment to quality and compliance
What to Expect (Job Responsibilities):
- Perform comprehensive medical record and claims review to make payment determinations for Medicare claims
- Conduct first and second levels of medical review regarding claims payment
- Analyze claims utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles
- Input medical review decisions using electronic health information systems
- Ensure compliance with departmental quality management systems and ISO requirements
What is Required (Qualifications):
- Must be a Registered Nurse with a Bachelor’s degree, Associate's degree, or Diploma in Nursing
- At least two (2) years of claims knowledge from billing, reviewing, or processing in a medical environment
- Minimum of four (4) years of clinical experience as a Registered Nurse
- At least two (2) years of experience with federal and local policy applications related to Medicare insurance
- Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
How to Stand Out (Preferred Qualifications):
- Prior experience as a Medicare Contractor Medical Review Nurse or Commercial Insurance RN
- Bilingual (Spanish) fluency, especially in reading and understanding medical records
#GovernmentServices #Healthcare #Medicare #NursingJobs #CareerOpportunity
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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.About the company
NCI is the leader in bringing artificial intelligence (AI) technology to the federal government. Our Shai™ AI solution and Empower platform provide our government customers with intelligent automation, Machine Learning, and code modernization, as well ...
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