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Clinical Fraud Waste Abuse (FWA) Subject Matter Expert (SME) Medical Review Nurse

Company: Integrity Management Services, Inc.
Location: Alexandria
Posted on: February 25, 2021

Job Description:

Intara Talent Solutions is continuously seeking remote Clinical Fraud Waste Abuse Subject Matter Experts/ Medical Review Nurses for our clients.Intara Talent Solutions - An IntegrityM BrandExperience* 10 years of experience in any combination of at least three of the following* Billing, coding, and medical record documentation processes in clinical settings;* Claims processing, including adjudication, payment, adjustment, demand and recovery* Medical review, including determinations, authorizations, peer review, utilization review, and appeals* Program integrity activities, including surveillance, step-edits, audits, surveys, pre-payment and post-payment review, investigations, referrals * Provider management, including credentialing, performance measurement, education, referral* Payment policy and regulation, including demonstrations, models, carve-outs, legislation* Multiple payers - Medicare, Medicaid, commercial* Multiple payer-types, including Fee-For-Service (FFS), managed care, capitatedSkills* Expertise in medical terminology and all healthcare coding (e.g., ICD-10, CPT, HCPCS)* Strong knowledge of health care benefit structure and claim processing systems* Experience researching and interpreting payer medical (coverage) policies (e.g., LCDs, NCDs, private carrier medical policies) and common industry claim edits (e.g., NCCI)* Ability to communicate technical and non-technical language to technical and non-technical audiences* Ability to prioritize multiple tasks to meet established deadlines and satisfy internal and external customer demands* Proficient in Microsoft products, Tableau* Bachelor's degree in relevant healthcare or related discipline * Registered Nurse (RN) and/or Bachelor of Science in Nursing (BSN) or similar caliber clinical training* Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA)RequirementsEducation and/or Credentials* Bachelor's degree in relevant healthcare or related discipline * Registered Nurse (RN) and/or Bachelor of Science in Nursing (BSN)

Keywords: Integrity Management Services, Inc., Alexandria , Clinical Fraud Waste Abuse (FWA) Subject Matter Expert (SME) Medical Review Nurse, Healthcare , Alexandria, Virginia

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