Registered Nurse Medical Reviewer

A company is looking for a Medical Review Specialist V. Key Responsibilities Review and analyze Medicare claims and associated medical records to determine payment based on coverage and coding guidelines Conduct in-depth claims analysis for potential fraudulent billing practices and complete summary reports based on findings Ensure compliance with Medicare and DOJ guidelines while maintaining confidentiality and security of information 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 is required; fraud review / investigation experience is preferred Ability to maintain confidentiality and adhere to ethical standards Proficient in Microsoft Excel, Word, and various internet applications