Job description
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
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
Preference:
- 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!
