Nurse Reviewer: RADV/Medical Coding in Owings Mills, MD

Nurse Reviewer: RADV/Medical Coding - Neil Hoosier & Associates, Inc. - Owings Mills, MD - work from home job

Company: Neil Hoosier & Associates, Inc.

Job description: Summary:

Medical professional responsible for evaluating and analyzing medical records, treatment plans, and healthcare claims to ensure they adhere to established medical guidelines and standards. Responsible for analyzing medical records, applying ICD-9-CM and ICD-10-CM coding guidance, and conducting training, oversight, and quality assurance activities. Your expertise in medical coding, knowledge of the Medicare Advantage program, and significant experience in medical record review quality assurance will be crucial for ensuring accurate and compliant data abstraction. A background in program integrity/fraud, waste, and abuse is preferred. Both full-time and part-time roles are available, and all are fully remote.

Responsibilities and Duties: * Review and interpret medical documentation to identify and extract pertinent clinical information.
• Inform diagnosis abstraction activities by providing a clinical basis for rendering specific diagnoses after analyzing medical records. Analyze medical records to abstract diagnoses using ICD-9-CM and ICD-10-CM coding guidance.
• Ensure accurate and consistent application of coding guidelines to abstract medical diagnoses from a variety of medical records
• Verify requirements are met, including reasonable and necessary adjudication, qualifications of reviewers, reviewing of medical records, steps in adjudication, determination of whether service is reasonable, and determination of whether service is necessary
• Attend required meetings and workgroups as needed to perform independent case reviews (e.g., procedural changes, sharing trends, reviewing information on specific case files, and discussing issues or questions)
• Utilize Internet resources for policy verification and regulations
• Utilize a modular application tool to document detailed evaluation finding
• Meet productivity and quality assurance standards

Qualifications: * Experience with Risk Data Adjustment Verification (RADV) is required • Registered Nurse (RN) with current active license • 10 or more years of experience within Medical and Health Services Management, with a focus on medical record review and coding • In-depth knowledge of ICD-9-CM and ICD-10-CM coding guidelines and the ability to apply them accurately and consistently and provide coding guidance to others • Familiarity with the Medicare Advantage program and its related data or records is preferred. • Working knowledge and understanding of Medicare coverage guidelines and clinical expertise to evaluate the medical necessity determination • Knowledgeable of the Medicare appeals process preferred • Medical Coding Certification (ICD-9-CM, ICD-10-CM, CPT-4 and HCPCS) preferred • Experience with Fraud, Waste and Abuse (FWA) is preferred • Investigative and analytical skills • Excellent written and oral communication skills • Proficiency with Microsoft Office Suite such as Outlook, Word, and Excel • Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program

NHA is a state and federal government contractor; all employees must be legally authorized to work in the United States. NHA does not provide sponsorship at this time.

NHA is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability or any other basis protected by law.

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Location: Owings Mills, MD

Job date: Sat, 09 Sep 2023 23:22:22 GMT

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