Registered Nurse / RN - Review & Evaluation (12218)
Review and Evaluation | Harrisburg, PA | Contract
Work Location: Harrisburg, PA
InGenesis is currently seeking a Registered Nurse / RN – Review & Evaluation to work with our client located in Harrisburg, PA. In this role, you will review cases to monitor compliance with State and Federal regulations, ensuring medical necessity, appropriateness, and quality of care/services.
If you meet the qualifications outlined below, apply today and we’ll reach out to answer any questions you may have!
• Ensure appropriateness and completion of services.
• Identify discrepancies in paid claims, itemized bills, and computer reports.
• Analyze cases for upcoding, duplicate billing, and unbundling of services billed.
• Utilize ICD-9CM diagnosis and procedure manuals, coding clinics, CPT/HCPCS manuals, etc.
• Prepare case findings, reports, charts, correspondence to providers, etc.
• Prepare potential cases of fraud.
• Testify at legal proceedings.
• Travel to on-site meetings, hearings, trainings, etc. as needed.
• Prepare claims to recover money for violations identified.
• Coordinate and participate in teleconferences, when requested by provider.
• Attend trainings, conferences, meetings, work groups, etc. as needed.
• Respond to complaints from multiple sources (website, letters, email, phone, etc.).
• Participate in managed care monitoring and research/special study projects, as needed.
• Perform other duties as necessary or assigned.
• Current Registered Nurse / RN license issued by the state of Pennsylvania.
• Preferred: Experience with durable medical equipment and/or physical, occupational, and speech therapies.
• Basic computer skills, including familiarity with Microsoft Office programs.
• Preferred: Knowledge of Inter-Qual Criteria and ICD-9 CM.
• Effective communication (written/verbal).
InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.
InGenesis is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at https://www.ingenesis.com/careers/site-accommodations.