|Healthcare Fraud Shield is seeking an experienced clinical reviewer who can perform the following duties: |
•Work collaboratively with other clinical reviewers (including performing quality check on work, assisting in research, discuss to make appropriate coding determinations in addition to the responsibilities outlined below.)
•Analyze and interpret patient medical records pertaining to FWA investigations.
•Compare information submitted on the claims to determine amount and nature of billable services.
•Determines appropriateness of billing and reimbursement.
•Documents findings for each claim line in a spreadsheet.
•Summarize findings in a written report.
•Abstracts CPT, HCPCS, Revenue Codes, DRG, and ICD-9/ICD-10 from medical records.
•Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations
•Other duties as needed.
Skills: •CPC is required. •RN, LPN, or NP required. •Knowledge of medical terminology. •Knowledge of coding including CPT, HCPCS, Revenue Codes, DRGs and ICD-9/ICD-10. •Knowledge of specialty medical practices. *Strong computer skills and the ability to use Excel •Must be detail-oriented. •Ability to communicate effectively both verbally and in writing. •Strong listening skills. •Independent. •Responsible. •Self-disciplined. •Ability to meet defined performance and production