Clinical Fraud Waste Abuse (FWA) Subject Matter Expert (SME) Medical Review Nurse
Company: Integrity Management Services, Inc.
Location: Alexandria
Posted on: February 25, 2021
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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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