Medical Review Specialist III Empower AI: As a casual Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment (DME). Perform projects or duties as assigned as a Medical Review Specialist. You will serve as a critical component in meeting our mission of providing excellent services to our clients. Your experience ensures an exciting and rewarding opportunity to be at the forefront of activities related to implementing healthcare reform on a national level. In assuming this position, you will be a critical contributor to meeting Empower AI's mission: To deliver innovative, cost-effective solutions and services that enable our customers to rapidly adapt to dynamic environments. Highlights of Responsibilities: Perform comprehensive medical record and claims review to make payment determinations based on insurance coverage, coding, and utilization of services and practice guidelines for Medicare DME. Performs first and second level of Medical Review in determination of claims payment review Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles Utilize electronic health information imaging and input medical review decisions by electronic database module. Utilize internet and intranet sources for policy verification. Utilize Microsoft Office suite and other software templates as associated source input for claims review. Make clinical judgment decisions based on clinical experience when applicable. Responsible for review of Medicare DME claims. Meeting quality and production standards. Ensuring departmental compliance with quality management system and ISO requirements. Completes other projects or duties as assigned by the Medical Review Lead Specialist Requirements: Must be a Registered Nurse obtained by either a Bachelor's degree – OR - Associate's degree – OR - Diploma in Nursing. At least four (4) years claims knowledge either from billing, reviewing, or processing of Durable Medical Equipment. At least three (3) years clinical experience as a Registered Nurse. Minimum two (2) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for Physician Office practices, Laboratory, and Ambulance Services. Current licensure as a Registered Nurse in one or more of the 50 states or D.C. Ability to keep sensitive and confidential material private. Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI). Preferred Education and Experience: Physician Office, Hospital, Supplier, or Clinic providing DME equipment care/services Prior work as a Medicare Contractor Medical Review Nurse or Commercial Insurance for DME Optional - Bilingual (Spanish) - Fluency in reading and understanding Spanish language especially as it relates to medical records is a plus! Physical Requirements: This position requires the ability to perform the below essential functions: Sitting for long periods Standing for long periods About Empower AI: All hiring and promotion decisions at Empower AI are based on merit to bring the best talent available to contribute to our firm's overall success. It is the policy of Empower AI not to discriminate against any applicant for employment, or employee because of age, color, sex, disability, national origin, race, religion, or veteran status. Empower AI is a VEVRAA Federal Contractor. If hired for this position, the base salary range would be within the range provided. The base salary range represents the anticipated low and high end of the salary range for this position. Actual salaries may vary based on various factors including but not limited to work location, skills, experience, gov con contractual requirements, and performance. The range listed is just one component of Empower AI's total compensation package for employees. Pay Band Min: USD $28.38/Hr. Pay Band Max: USD $43.94/Hr. Empower AI
...diligently to maintain the highest level of performance and quality standards in their industry. Position Summary: The Executive Assistant will assist senior leaders to stay organized, focused, and productive by managing schedules, coordinating communication, and...
...Job Description Job Description About the Role: The HVAC TECH Engineering Associate plays a critical role in ensuring the optimal performance, safety, and efficiency of heating, ventilation, and air conditioning systems within educational facilities. This position...
...Job Description Job Description Description: The Warehouse Associate/Van Driver is responsible for all functions pertaining to shipping and receiving. Other responsibilities will include delivering, verifying, and documenting the quality and quantity of all incoming...
...medical field/environment or as a military medic.Higher educational degree/training may substitute for experience.One year of Orthopedic Tech experience preferredLicensure/ Certifications N/ASalary & Benefits The posted pay range is Boston Children's reasonable and...
...Competitive Compensation Great Work Environment Career Advancement Opportunities Job Summary We are seeking a Tow Truck Driver to join our team! As a Tow Truck Driver on our team, you will be responding to calls from stranded motorists in the area and...