Medical Review Nurse – Medicare

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $66k - $106k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Peraton

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

Peraton is a mission-focused enterprise that supports national security initiatives through advanced IT and cyber services. They provide capabilities in areas such as cyber defense, cloud operations, engineering, and intelligence. With a commitment to solving complex challenges, Peraton integrates data-driven technologies to ensure mission success for their military and government clients.

📋 Description

• Conduct medical record reviews and apply sound clinical judgment to claim payment decisions • Research medical claims data and other information to identify problems • Review sophisticated data model output and use tools to detect potential fraud • Support ongoing fraud investigations and requests for information • Identify and develop cases for administrative action, including law-enforcement referral, education, and overpayment recovery • Work with external agencies to develop cases and corrective actions • Respond to requests for data and support • Present issues of concern, citing regulatory violations and alleging schemes or scams to defraud the Government • Research regulations and cite violations • Conduct self-directed research into Medicare payments to institutional and non-institutional providers • Appear in court to testify about work findings when required

🎯 Requirements

• 5 years with Bachelor’s degree, or 3 years with a Master’s degree, or 7 years with an Associate’s degree • Experience in the medical field as a Registered Nurse or other clinician, and/or experience reviewing medical claims for coverage and medical necessity • Current nursing license; active license in the US • Strong investigative skills • Strong communication and organization skills • Strong PC knowledge and skills • US citizenship required • Ability to appear in court to testify about work findings • Ability to compose correspondence, reports, and referral summary letters • Ability to handle confidential material • Ability to report work activity in a timely manner • Ability to work independently and as a member of a team • Ability to attend meetings, training, and conferences • CPC (Certified Professional Coder) certificate is desirable

🏖️ Benefits

• Telework available from any state • Overtime eligibility may apply • Shift differential may apply • Discretionary bonus may be available • Overnight travel required