Integrity Management Services, Inc.

Compensation

Full Description

Job Description: • Conduct medical record reviews and apply sound clinical judgment to claim payment decisions • Additional research on medical claims data and other sources of information to identify problems • Review sophisticated data model output • Utilize a variety of tools to detect situations of potential fraud • Support ongoing fraud investigations and requests for information • Research national and local policy as well as Medicare and/or Medicaid guidelines for supporting references in review determinations • Conduct reviews under the guidance of a Medical Review Manager/supervisor Requirements: • Current/active RN license • 5-7 years of experience in the medical field as a Registered Nurse or other clinician • Experience in review of medical claims for coverage and medical necessity • Strong investigative skills • Demonstrated proficiency in Medical Review work • Working knowledge of Medicare and Medicaid • Excellent communication skills • Demonstrated prioritization, problem solving, and organization skills • Strong computer skills including Microsoft Office proficiency • All candidates MUST pass a background check and drug screening prior to employment**Preference:** • Bachelors in of Science in Nursing (BSN) • 2+ years’ clinical experience • Coding certificateEnthusiastic individuals who can work effectively in a dynamic environment both in a team as well as independently is a must! Benefits: