Medical Reviewer, LPN

Job Description

Elara Caring is looking for a Medical Reviewer. In this role, you'll gather medical records, review them for billing compliance, and send them to payers as needed. Your job involves analyzing claims and medical records to see if medical services are covered. You'll also prepare reports on your findings and send records to the payer when they ask for them.

Qualifications

1. Must have a diploma from an accredited school as a Licensed Practical Nurse or Licensed Vocational Nurse. 2. Must have a current license as a Licensed Practical Nurse or Licensed Vocational Nurse. 3. Must have 3 years of experience as a licensed practical nurse or licensed vocational nurse in a home health and/or hospice clinical care setting. 4. Prior experience in medical review (Utilization Review, Case Management, and knowledge of billing and coding guidelines) is preferred. 5. Must have demonstrated communication, negotiation, critical thinking, and organizational skills. 6. Must have an ongoing understanding of current Medicare, Medicaid, and third-party regulations as changes occur. 7. Must have knowledge in all levels of home health, hospice, palliative, and home medical equipment practices. 8. Must have advanced computer skills with proven ability to multitask effectively across dual-screen environments.

Benefits

- Competitive compensation package - Tuition reimbursement for full-time staff and continuing education opportunities for all employees at no cost - Opportunities for advancement - Comprehensive insurance plans for medical, dental, and vision benefits - 401(K) with employer match - Paid time off, paid holidays, family, and pet bereavement - Pet insurance