Medical Claims Review Nurse Job

MEDICAL CLAIMS REVIEW NURSE needed for a CONTRACT opportunity with Yoh's client located in Sacramento, CA.

Top Skills You Should Possess:
- Utilization Management experience
- Knowledge of CPT and ICD-9 coding

What You'll Be Doing:
- Provide timely medical review of claims and claims appeals related to CPT, HCPCS and/or ICD-9 coding, to ensure accuracy of modifiers, place of service and/or date of service and to make processing recommendations per established medical and/or coding criteria/conventions
- Perform retroactive review of claims requiring medical review, edits, and medical necessity submitted with and/or without prior authorization
- Verify and identify that claims and authorizations are reviewed for medical and coding appropriateness pre- and post-payment
- Review, refer and manage possible CCS cases

What You Need to Bring to the Table:
- Current California RN or LVN license
- Three (3) years recent utilization management or quality management experience in a clinical setting
- Strong knowledge/understanding of CPT, HCPCS and ICD-9 coding required
- Strong knowledge/understanding of RBRVS-based and Medi-Cal fee schedules or payment systems required
- Understanding of the National Correct Coding Initiative and CPT coding rules/standards
- In-depth knowledge of AB-1455, regulations and procedures governing Medi-Cal and other state sponsored programs
- Direct experience in utilization management and/or quality management is required

Bonus Points! Otherwise Known As Preferred Qualifications:
- Masters Degree in Nursing or a related field preferred
- Working familiarity with the basic principles of contract law, risk management and health care economics

WHAT ARE YOU WAITING FOR? APPLY NOW!

RECRUITER: Jennifer Andersen

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.

J2W: HC

MONJOBJ2WNWHLTH

Ref:

SFSF: REN