Medical Review Analyst (Registered Nurse) (Full-time, Remote)

Integrity Management Services, Inc. • Alexandria, VA

30d • Remote

About The Position

Integrity Management Services, Inc. (IntegrityM) is a woman-owned small business specializing in assisting government healthcare organizations prevent and detect fraud and abuse in their programs. At IntegrityM, we offer a culture of opportunity, recognition, and collaboration. We thrive off of these fundamental elements that make IntegrityM a great place to work. We offer the flexibility our employees need to challenge themselves and focus on advancing their professional development and careers. Large company perks. Small company feel. http://www.integritym.com We are seeking a Medical Review Analyst (RN) with medical review experience to join our team. The position requires the individual to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions. Responsibilities may include additional research on medical claims data and other sources of information to identify problems, review sophisticated data model output, and utilize a variety of tools to detect situations of potential fraud and to support the ongoing fraud investigations and requests for information Research national and local policy as well as Medicare and/ or Medicaid guidelines for supporting references in their review determinations Conduct reviews under the guidance of a Medical Review Manager/supervisor

Requirements

• Current/active RN license
• 5-7 years of experience in the medical field as a Registered Nurse or other clinician
• Experience in review of medical claims for coverage and medical necessity
• Strong investigative skills
• Demonstrated proficiency in Medical Review work
• Working knowledge of Medicare and Medicaid
• Excellent communication skills
• Demonstrated prioritization, problem solving, and organization skills
• Strong computer skills including Microsoft Office proficiency
• All candidates MUST pass a background check and drug screening prior to employment

Nice To Haves

• Bachelors in of Science in Nursing (BSN)
• 2+ years’ clinical experience
• Coding certificate
• Enthusiastic individuals who can work effectively in a dynamic environment both in a team as well as independently is a must!

Responsibilities

• Conduct medical record reviews
• Apply sound clinical judgment to claim payment decisions
• Research on medical claims data and other sources of information to identify problems
• Review sophisticated data model output
• Utilize a variety of tools to detect situations of potential fraud and to support the ongoing fraud investigations and requests for information
• Research national and local policy as well as Medicare and/ or Medicaid guidelines for supporting references in their review determinations
• Conduct reviews under the guidance of a Medical Review Manager/supervisor

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 101-250 employees