Nurse Reviewer, LPN

🔥 4 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $67.5k - $75k / year

⏰ Full Time

🟢 Junior

👻 Ghost score 0%

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FHAS, LLC

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1996

⚖️ Legal

💼 Consulting

📦 Logistics

Legal • Consulting • Logistics

FHAS, LLC is a provider of data-driven medical review, appeals management, independent dispute resolution (IDR), and hearings/adjudication services for health plans, federal and state agencies, and government contractors. The company combines accredited clinical and legal expertise with AI-augmented, cloud-based platforms to deliver scalable, compliant reviews, claims adjudication, provider education, and dispute resolution that reduce improper payments, improve regulatory compliance, and accelerate case outcomes.

📋 Description

• Provide timely review and determination of medical claims, including prior authorization, appeals, and other types of medical claims • Analyze medical records related to case files • Review and interpret Local Coverage Determination (LCD), National Coverage Determination (NCD) policies, and other federal regulations • Apply appropriate regulatory citations, including health plan policies, NCDs/LCDs, and other regulations, to each claim • Formulate narrative decisions citing relevant regulatory backup documentation in the medical record • Adjudicate claims based on regulations and documentation in the medical record • Attend FHAS and/or client Lunch & Learn sessions and general training sessions on site as needed • Complete IRR surveys in a timely manner as required by the prime contractor • Maintain a 97% or higher quality score • Review findings/results effectively with management • Operate a computer and other office equipment such as a telephone

🎯 Requirements

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification preferred • Maintain professional licensure in active and unrestricted status as required by state of issuance • Must possess a current, unrestricted State license as an LPN, as required by contract(s) • 1+ years clinical experience required • Coding, utilization, and/or medical chart review preferred • Professional Coding Certification preferred • Detailed knowledge of Medicare regulations and guidelines, policies, and payor reimbursements preferred • Knowledge of CPT, HCPCS, ICD-10 codes and coding guidelines • Ability to identify Medicare billing and payment irregularities • Exceptional analytical, written, and oral communication skills • Proficient with PC and related software programs • Excellent organizational skills • Must be a team player • Must be able to remain in the stationary position 95% of the time • Regular and predictable attendance is essential

🏖️ Benefits

• Attend FHAS and/or client Lunch & Learn sessions and/or general training sessions on site as needed • Limited travel may be required

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