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Claims Reviewer, RN (BHJOB1435_26982) VR

Astyra Corporation Glen Allen, VA

  • Expired: over a month ago. Applications are no longer accepted.
Job Description

Astyra is seeking a Claims Reviewer, RN who will independently review/audit various claims, medical records, and program compliance relating to Medicaid and Medicare engagements.

Essential Functions:

  • Develop and maintain general knowledge of reimbursement regulations, provider billing manuals, and other Medicaid policies
  • Review hospital in-patient DRG coding for the correctness
  • Participate in desk and on-site examinations of Medicaid providers to review clinical documentation
  • Interpret and analyze health care data
  • Utilize healthcare knowledge and experience to review medical records for various types of medical services for accuracy, completeness, and consistency with professional standards and compliance with billing and coding requirements
  • Document and report findings of reviews and audits in accordance with professional standards and project protocols
  • Prepare concise and well-written reports, memos, and proposals
  • Lead meetings, team projects, and discuss current topics with clients
  • Maintain security of and confidentiality of all protected health information
  • Perform additional assignments relating to Medicaid reimbursement and Medicare compliance
  • Participate in and contribute to the quality management system
  • A high level of dependability and accountability to meet predefined production and quality standards
  • An organized approach to work and the ability to function at a high degree of independence, urgency, accuracy, thoroughness, and attention to detail
  • Additional responsibilities as assigned

Requirements:

  • Bachelor’s degree in Nursing required (Associate’s Degree from accredited nursing school with 4 or more years of additional clinical experience may be substituted in lieu of a bachelor’s degree) and current RN license in good standing
  • Licensed Registered Nurse with a current Virginia license
  • Minimum 3 years of clinical review experience with utilization management, case management, or health care claims auditing experience
  • Certified Professional / Hospital Coder Certification (CPC, CIC, COC, CPMA, CCS, CCS-P, RHIA, RHIT ) preferred or proof that certification has been obtained within 12 months
  • Working knowledge and experience in detecting and investigating health insurance fraud, waste, and abuse preferred
  • Working knowledge with healthcare coding principles to include ICD-9, ICD-10, CPT, HCPCS, RUGS, and DRG
  • Experience and knowledge of State and Federal healthcare regulations
  • Knowledge of Medicaid reimbursement and coverage policies desired
  • Proficient use of applicable software programs, including Microsoft Windows, Word, and Excel
  • Strong analytical and problem-solving skills
  • Excellent communication skills including written and verbal. Ability to present to large or small groups required.
  • Ability to work independently under general instructions, self-directed and motivated
  • Ability to manage multiple deadlines and prioritize assignments
  • Ability to work in a team environment
  • Well organized with a high degree of accuracy and attention to detail

Expectations:

  • This position is expected to be in office 1-2 days a week near Innsbrook with remote work

Not currently sanctioned or excluded from any program operated by Federal or State Agencies including Medicare and Medicaid

 

 

Company Description
Astyra Corporation is a staffing and consulting company that is locally owned and operated right here in the heart of RVA. Astyra offers a unique approach to solving the business challenges of its clients. After being in business for over 20 years, we have evolved and grown - smart ideas, ingenuity and never settling for failure are our hallmark traits. We are locals with a national presence and need a like-minded; client-focused professional who wants to make a difference every day.

Astyra Corporation

Why Work Here?
Innovative, growing industry with smart ideas, ingenuity and never settling for failure!

Astyra Corporation is a staffing and consulting company that is locally owned and operated right here in the heart of RVA. Astyra offers a unique approach to solving the business challenges of its clients. After being in business for over 20 years, we have evolved and grown - smart ideas, ingenuity and never settling for failure are our hallmark traits. We are locals with a national presence and need a like-minded; client-focused professional who wants to make a difference every day.

Astyra Corporation's Logo

Address

Glen Allen, VA
USA

Industry

Finance and Insurance

Website

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