Machinify
Healthcare
MedicalReviewNurseClinicalValidation
“Medical Review Nurse - Clinical Validation at Machinify. Skills: Medical claims audit, Clinical validation, ICD-10-CM/PCS, DRG methodologies. Perform medical claims audit reviews. Conduct retrospective audits”
Industry & Context.
Analytical skills; Critical judgment; Root cause analysis
What They're Looking For.
Must Have
Active/unrestricted RN license, 2 years inpatient claims auditing experience, 2 years inpatient clinical documentation integrity experience
Nice to Have
CCDS certification, CDIP certification, CCS certification, CIC certification
What You'll Do.
Perform medical claims audit reviews
Conduct retrospective audits
Conduct prepayment audits
Audit claims for medically appropriate services
Apply medical review guidelines
Document all findings
Generate letters articulating audit findings
Support findings during appeals process
Identify potential abuse
Obtain approval for vulnerabilities
Keep abreast of medical practice changes
Keep abreast of technology changes
Keep abreast of regulatory issues
Minimize number of appeals
Suggest audit improvements
Assist with QA functions
Cross train in clinical departments
How You'll Work.
Team & Collaboration
Audit team; Multi-location team; Work independently; Work as a team
Communication Scope
Written communication; Verbal communication
Process & Methodology
Manage multiple tasks, Manage multiple assignments, Organize workload, Prioritize workload
Applying for this Medical Review Nurse - Clinical Validation role?
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ANONYMOUS · UNFILTERED
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