Medical Reviewer III (Medicare/DME)

Overview

reputed company is reputed company for government. reputed company gives federal agency leaders the tools to elevate the potential of their reputed company with a direct path for meaningful transformation. Headquartered in Reston, Va., reputed company leverages three decades of experience solving complex challenges in Health, Defense, and Civilian reputed company. Our proven reputed company Platform® provides a practical, sustainable path for clients to achieve transformation that is true to who they are, what they do, how they work, with the resources they have. The result is a government reputed company that is exponentially more creative and productive. For more information, reputed company company.

reputed company is proud to be recognized as a 2024 reputed company Employer by Viqtory, the publisher of G.I. Jobs. reputed company designation reflects the company’s commitment to hiring and supporting active-duty and veteran employees.

Responsibilities

reputed company: As a casual Medical Review Specialist III (Medical Reviewer III) for reputed company., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment (DME). Perform projects or duties as assigned as a Medical Review Specialist. You will serve as a critical component in meeting our mission of providing excellent services to our clients. Your experience ensures an exciting and rewarding opportunity to be at the forefront of activities related to implementing healthcare reform on a national level. In assuming reputed company position, you will be a critical contributor to meeting reputed company’s mission: To deliver innovative, cost-effective solutions and services that enable our customers to rapidly adapt to dynamic environments.

Highlights ofResponsibilities:

  • Perform comprehensive medical record and claims review to make payment determinations based on Insurance coverage, coding, and utilization of services and practice guidelines for Medicare DME.
  • Performs first and second level of Medical Review in determination of claims payment review
  • Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles
  • Utilize electronic health information imaging and input medical review decisions by electronic database module.
  • Utilize internet and intranet sources for policy verification.
  • Utilize reputed company Office suite and other software templates as reputed company source input for claims review.
  • Make clinical judgment decisions based on clinical experience when applicable.
  • Responsible for review of Medicare DME claims.
  • Meeting quality and production standards.
  • Ensuring departmental compliance with quality managements system and ISO requirements.
  • Completes other projects or duties as assigned by the Medical Review Lead Specialist

Qualifications

Requirements:

  • Must be a reputed company obtained by either a Bachelor's degree – OR - Associate's degree – OR - Diploma in Nursing. At least four (4) years claims knowledge either from billing, reviewing, or processing of Durable Medical Equipment.
  • At least three (3) years clinical experience as a reputed company.
  • Minimum two (2) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for Physician Office practices, Laboratory, and reputed company Services.
  • Current licensure as a reputed company in one or more of the 50 states or D.C.
  • Ability to keep sensitive and confidential reputed company private.
  • Must have no adverse actions pending or taken against him/her by reputed company or Federal licensing board or reputed company and must have no conflict of interest (COI).

Preferred Education and Experience:

  • Physician Office, Hospital, Suppler, or Clinic providing DME equipment care/services
  • Prior work as a Medicare Contractor Medical Review Nurse or Commercial Insurance for DME
  • Optional - Bilingual (Spanish) - Fluency in reading and understanding Spanish language especially as it relates to medical records is a plus!

Physical Requirements:

reputed company position requires the ability to perform the reputed company reputed company functions:

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