- Entry Level Software Engineer Job at Belay Technologies in Highland Bch Maryland
- Belay Technologies in Maryland, , United States
- jobs
- 3 weeks ago
jobs description
Job ID : 24-04101Registered Nurse Medical Review Medicaid MedicareBaltimore MDPay From : $45 Per HourMUST :The Registered Nurse Medical Review Manager Medicaid Medicare Reviewer s experience includes but is not limited to the following :Licensed as a Registered Nurse5+ years of clinical experience as a Registered Nurse5+years of medical review experience in Medicare PI investigatio...ns or demonstrated experience reviewing, analyzing and developing information and making decisions in support of allegations of fraud or abuse.Experienced with Comprehensive Error Rate Testing Accuracy effort, the Unified Program Integrity Contractor effort or the Supplemental Medical Review Contractor3+ years of supervisory experience supporting Medicare Part A and BExperience processing and reviewing Medicare and Medicaid claims including Clinical Review JudgementExperience handling payment reviews focused on coverage, policy and payment rules, including review of Medicare beneficiary medical records and claimsProficient with MS Office (Project, Visio, Word, Excel, PowerPoint, Outlook) skillsDUTIES :The duties of the Medical Review Manager Registered Nurse include but are not limited to the following :Manage and oversee the delivery of the medical review program with the Centers for Medicare and MedicaidSupport Medicare Part A and B payment reviews focused on coverageReview Medicare beneficiary medical records and claims using clinical review judgment.Evaluate and implement the Medical Review and quality control / quality processesImplement Quality Control / Quality Assurance processesEnsure timely submission of Program Integrity (PI) required reportsEnsure compliance with Program Integrity SecurityReview, analyze, and develop information, and make decisions in support of allegations of fraud, and abuseHandle the medical review processes of either the Comprehensive Error Rate Testing Accuracy effort, the Unified Program Integrity Contractor effort, or the Supplemental Medical Review ContractorQuadrant is an affirmative action / equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, status as a protected veteran, or status as an individual with a disability. Healthcare benefits are offered to all eligible employees according to compliance mandated by the Affordable Care Act .
Maryland United States