Medical Reviewer III – Medicare, DRG

Job Description

Join Empower AI as a Medical Reviewer III and play a pivotal role in ensuring the integrity of Medicare claims. This position involves performing comprehensive medical record and claims reviews for Diagnosis Related Group (DRG) claims, contributing significantly to our mission of delivering exceptional services to our clients. You'll conduct in-depth claims analysis using ICD-10-CM, CPT-4, and HCPCS Level II coding principles. Leveraging your clinical experience, you'll make informed clinical judgment decisions and complete additional projects or duties as assigned by the Medical Review Lead Specialist.

Qualifications

To thrive in this role: 1. You must be a Registered Nurse with a Bachelor's, Associate's degree, or Diploma in Nursing. 2. You need at least four (4) years of claims experience in billing, reviewing, or processing Durable Medical Equipment. 3. You should possess a minimum of three (3) years of clinical experience as a Registered Nurse. 4. You need at least two (2) years of experience applying federal and local policies related to Medicare insurance procedures for medical necessity in Physician Office practices, Laboratory, and Ambulance Services. 5. You must hold a current Registered Nurse license in one or more of the 50 states or D.C. 6. You must be able to maintain the confidentiality of sensitive information. 7. You must not have any pending or adverse actions taken against you by any State or Federal licensing board or program and must have no conflict of interest (COI).

Benefits

Empower AI offers: - Health insurance - 401(k) matching - Professional development opportunities