Online Proofreading Jobs Remote Medical Review Analyst

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

Click Here : Apply Now