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Registered Nurse / RN - Review & Evaluation (8256)

Review and Evaluation | Harrisburg, PA | Contract

Job Description
Registered Nurse / RN – Review & Evaluation
Work Location: Harrisburg, PA

InGenesis is currently seeking a Registered Nurse / RN to evaluate medical care and services rendered by inpatient/outpatient hospital-based services, rehabilitation, and hospice providers. In this role, you will monitor services for medical necessity, appropriateness, and quality of care, verifying that all services ordered were rendered.

If you meet the qualifications outlined below, apply today and we’ll reach out to answer any questions you may have!

Job Duties/Responsibilities
• Analyze paid claims, itemized bills, and computer reports to identify discrepancies.
• Analyze data for up coding, duplicate billing, and unbundling of services billed.
• Utilize ICD-9-CM diagnosis and procedure manuals, coding clinics, CPT and HCPCS manuals, etc. to ensure claims are billed appropriately.
• Select and analyze cases retrospectively to monitor compliance with state/federal regulations.
• Track case progress with section supervisor and case tracking system.
• Perform in-house and on-site reviews to assess the medical care rendered by providers.
• Coordinate and participate in teleconferences/meetings, when requested, to discuss review processes or case findings.
• Participate in evidentiary meetings to discuss case and prepare for litigation proceedings.
• Prepare written material to carry out necessary review activities (provide case findings, refer information, communicate with recipients/providers, etc.).
• Responds to complaints from multiple sources (web site, letters, email, phone, etc.).
• Perform other duties as assigned.

Minimum Qualifications
• Current Registered Nurse / RN license in the state of Pennsylvania.
• Knowledge of Inter-Qual Criteria and ICD-9-CM, preferred.
• Proficiency in Microsoft Office products.
• Effective communication (verbal/written).