Medical Review Nurse – CMS RAC, Government Audits

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🕒 June 29

🐊 Florida – Remote

🐊 Florida – Remote

💵 $81k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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BASF

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1865

🚘 Automotive

🏗️ Construction

🏥 Healthcare

Automotive • Construction • Healthcare

BASF is a global chemical company that operates across multiple sectors, providing a wide range of products and solutions. The company is focused on innovation and sustainability, serving industries such as agriculture, automotive, construction, electronics, energy, and healthcare. With a commitment to research and development, BASF aims to create chemicals that enhance the quality of life and support sustainable practices worldwide.

📋 Description

• Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules. • Document all findings referencing the appropriate policies and rules. • Generate letters articulating audit findings. • Supporting your findings during the appeals process if requested. • Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse. • Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits. • Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients. • Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows; Assist with QA functions and training team members. • Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines. • Interface with and support the Medical Director and cross-train in all clinical departments/areas. • Other duties as required to meet business needs.

🎯 Requirements

• Active unrestricted RN license in good standing, required. • Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting. • One (1) or more years' experience performing medical records review. • One (1) or more years' experience in health care claims that demonstrates expertise in ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required. • Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.

🏖️ Benefits

• medical • dental • vision • HSA/FSA options • life insurance coverage • 401(k) savings plans • family/parental leave • paid holidays • paid time off annually