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| Job Locations | US-Remote | Category | Administration / Clerical | Type | Regular Full-Time |
Empower AI is AI for government. Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. Our proven Empower AI 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 workforce that is exponentially more creative and productive. For more information, visit www.Empower.ai.
Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs. This designation reflects the company's commitment to hiring and supporting active-duty and veteran employees.
Empower AI: As a Medical Review Specialist III (Medical Reviewer III) you will primarily perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare PART A- Skilled Nursing Facilit (SNF). 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.
Highlights of Responsibilities:
* 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 Part A SNF
* 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 Microsoft Office suite and other software templates as associated source input for claims review.
* Make clinical judgment decisions based on clinical experience when applicable.
* Responsible for review of Medicare Part A 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
MINIMUM REQUIREMENTS:
- At least four (4) years clinical experience as a Registered Nurse.
- Minimum two (2) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for SNF, Inpatient, and/or Outpatient Facilities and Services.
- Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
- Ability to keep sensitive and confidential material private.
- Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI).
- Must have and maintain a valid state driver's license for the state of residence.
Preferred Education and Experience:
- SNF, Inpatient, Outpatient Services RN clinical and/or administrative nursing experience
- Prior work as a Medicare Contractor Medical Review Nurse or Commercial Insurance RN
- Optional - Bilingual (Spanish) - Fluency in reading and understanding Spanish language especially as it relates to medical records is a plus!
Physical Requirements:
This position requires the ability to perform the below essential functions:
- Sitting for long periods
- Standing for long periods
- Ambulate throughout an office
- Ambulate between several buildings
- Stoop, kneel, crouch, or crawl as required
It is the policy of Empower AI to provide equal opportunity in recruiting, hiring, training, and promoting individuals in all job categories without regard to race, color, religion, national origin, gender, age, disability, genetic information, veteran status, sexual orientation, gender identity, or any other protected class or category as may be defined by federal, state, or local laws or regulations. In addition, we affirm that all compensation, benefits, company-sponsored training, educational assistance, social, and recreational programs are administered without regard to race, color, religion, national origin, gender, age, disability, genetic information, veteran status, sexual orientation, or gender identity. It is our firm intent to support equal employment opportunity and affirmative action in keeping with applicable federal, state, and local laws and regulations. Empower AI is a VEVRAA Federal Contractor.
It is the policy of NCI to provide equal opportunity in recruiting, hiring, training, and promoting individuals in all job categories without regard to race, color, religion, national origin, gender, age, disability, genetic information, veteran status, sexual orientation, gender identity, or any other protected class or category as may be defined by federal, state, or local laws or regulations. In addition, we affirm that all compensation, benefits, company sponsored training, educational assistance, social, and recreational programs are administered without regard to race, color, religion, national origin, gender, age, disability, genetic information, veteran status, sexual orientation, or gender identity. It is our firm intent to support equal employment opportunity and affirmative action in keeping with applicable federal, state, and local laws and regulations. The information above has been designed to indicate the general nature and level of work performed by employees within the classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this position.