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RN - Risk Adjustment Clinical Reviewer (8415)

Claims Review Mgmt | Richardson, TX | Contract

Job Description
RN – Risk Adjustment Clinical Reviewer
Work Location: Richardson, TX

InGenesis is currently seeking a Registered Nurse / RN to work as a Risk Adjustment Clinical Reviewer for our client located in Richardson, TX. In this role, you will review medical record documentation, looking for validating information that supports claims data submitted by providers.

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

Job Duties
• Prepare medical records by applying structured auditing criteria.
• Move records through check points as defined by approved systematic process.
• Discern when dates gaps exist for missing records.
• Provide information to chaser(s) for follow up request of additional records.
• Perform some claims investigations/research.
• Work in a database environment, using multiple PC apps simultaneously.
• Perform other duties as assigned.

Minimum Qualifications
• Current Registered Nurse / RN license in the State of Texas.
• 2+ years of clinical experience.
• 1+ year of experience performing chart audits and review.
• Experience using or viewing electronic medical records.
• Knowledge of clinical data auditing or HHS risk management.
• Computer proficiency.
• Clear and concise communication skills (verbal/written).
• Strong skillset in organization, task prioritization, and analytical skills.
• Preferred: Coding experience.