Position: Nurse, Clinical Medical Review
Location: Baltimore, MD #HYBRID ( need for on-site medical record retrieval)
Duration: 6+months Contract
Rate: $35/hr
Job Description :
ESSENTIAL FUNCTIONS :
35% Receives, researches, reviews and analyzes professional and institutional claims using critical thinking, nursing clinical judgment and corporate/medical policies for claims processing and/or adjudication, Performs high-level research on topics identified as actual or potential medical policies. Assesses and communicates impact of information on medical policy.
25% Provides pricing of procedure codes which require individual consideration or are listed as "not otherwise classified" in CPT manual. Interprets the descriptive or medical information utilizing the CPT and HCPCS manuals. Keeps up-to-date on coding rules and standards.
25% Participates in medical policy meetings, nurses' forums, and review sessions with Medical and Dental directors, special projects and task forces committees as assigned.
15% Performs medical underwriting and risk assessment by reviewing applications of potential subscribers, as well as any appropriate medical records.
Thanks & Regards,
--
LAXMAN
Team Lead - Talent Acquisition
KMM Technologies, Inc.
CMMI Level 2 | ISO 9001 | ISO 20000 | ISO 27000 Certified
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