Job Responsibilities : Medical Review Analyst – Remote
Salary : $69000 per year
Company : Piper Companies
Location : Remote US
Responsibilities of the Medical Review Analyst:
- Analyze records and utilize clinical experience to determine pre-existing, medical necessity, benefit eligibility and/or appropriate reimbursement for claims and/or products.
- Responsible for identifying, documenting, and escalating system and process issues. If issues arise, determine root cause and recommend solutions and complete correction.
- Review claims submitted by medical personnel and members by utilizing clinical knowledge. Determine medical necessity or treatment and refer cases accordingly.
- Monitor billing and document inappropriate usage or utilization trends.
- Maintain communication for members and providers about the status of their claims and medical reasoning behind decisions.
Qualifications of the Medical Review Analyst:
- RN/LPN North Carolina (NC) license
- Strong computer skills
- 3+ years of hands on clinical experience
- Medical billing experience preferred, but not required
Compensation of the Medical Review Analyst:
- Salary: based on relevant experience
- Comprehensive Benefits: Cigna Healthcare, MetLife Dental, VSP Vision, 401K