Machinify
Healthcare
MedicalReviewNurseIISNF/MDSAuditor
“Medical Review Nurse II - SNF/MDS Auditor at Machinify. Skills: MDS auditing, Medical review guidelines, Claims auditing. Perform SNF medical claims audit reviews. Conduct retrospective and prepayment audits”
Industry & Context.
What They're Looking For.
Must Have
Active unrestricted RN license, Not sanctioned or excluded from Medicare, 5+ years diversified nursing experience, 1+ years MDS/RAI process experience, 1+ years medical records review experience, 1+ years healthcare claims experience, Expertise in ICD-9/ICD-10 coding guidelines, Comprehension of UB-04 form
Nice to Have
Experience performing utilization review, Understanding of PDPM HIPPS codes, Knowledge of RUG and LOC commercial payors
What You'll Do.
Perform SNF medical claims audit reviews
Conduct retrospective and prepayment audits
Audit claims for medically appropriate services
Apply appropriate medical review guidelines
Document all findings
Generate letters articulating audit findings
Support audit findings during appeals
Identify potential abuse cases
Improve medical policies
Improve provider education
Keep abreast of medical practice
Keep abreast of technology changes
Keep abreast of regulatory issues
Minimize audit errors
Suggest audit workflow improvements
Assist with QA functions
Participate in edit parameter establishment
Participate in new issue packet development
Participate in Medical Review Guidelines development
Interface with Medical Director
Support Medical Director
Cross train in clinical departments
How You'll Work.
Team & Collaboration
Audit team; CMD colleagues; Other contractors; Clients; Medical Director
Communication Scope
Written communication; Verbal communication
Applying for this Medical Review Nurse II - SNF/MDS Auditor role?
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ANONYMOUS · UNFILTERED
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