Registered Nurse Medical Reviewer - job 2 of 3

Job Summary

A company is looking for a Medical Review Specialist V.

Key Responsibilities

• Review and analyze Medicare claims and associated medical records for payment determinations
• Conduct in-depth claims analysis to detect potential fraudulent billing practices
• Complete summary reports and communicate findings in accordance with established guidelines

Required Qualifications

• Registered Nurse (RN) with current licensure in one or more states or D.C
• At least 10 years of clinical experience and a minimum of 7 years of claims knowledge
• Medical review experience required; fraud review/investigation experience preferred
• Must have no adverse actions pending or taken against them by any licensing board
• Ability to maintain confidentiality and handle sensitive information