Medical Reviewer III – Medicare, DRG

Job not on LinkedIn

🕒 May 28

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

🔍🏥 Medical Reviewer

👻 Ghost score 45%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Empower AI

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1989

🎖️ Defense

🏥 Healthcare

📦 Logistics

Defense • Healthcare • Logistics

Empower AI, formerly known as NCI, is a company that enhances the capabilities of public sector teams through advanced artificial intelligence solutions. With a focus on federal agencies, Empower AI leverages its extensive technical expertise to address complex challenges in both Civilian and Defense missions, enabling government leaders to boost workforce productivity and make informed decisions quickly. The company's offerings encompass a range of specialties, including AI, cybersecurity, software development, and cloud migration, aimed at facilitating meaningful transformation within government operations.

📋 Description

• Perform Medicare comprehensive medical record and claims review for DRG claims • Conduct in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles • Utilize electronic health information imaging and input medical review decisions by electronic database module • Utilize internet and intranet sources for policy verification • Responsible for review of Medicare DRG claims • Meet quality and production standards

🎯 Requirements

• Must be a Registered Nurse (Bachelor's degree, Associate's degree, or Diploma in Nursing) • At least four (4) years claims knowledge (billing, reviewing, or processing of Durable Medical Equipment) • At least three (3) years clinical experience as a Registered Nurse • Minimum two (2) years federal and local policy applications in relation to Medicare insurance • Current licensure as a Registered Nurse in one or more of the 50 states or D.C. • Ability to keep sensitive and confidential material private • Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI)

🏖️ Benefits

• 2024 Military Friendly Employer recognition • Commitment to hiring and supporting active-duty and veteran employees