PS - Payment Integrity Clinician I (B05226)
RN Integrity Clinician – Remote work.
Our client, a leading health care company dedicated to revolutionizing the industry, is seeking a licensed, unrestricted registered nurse for their Integrity Clinician role, essentially a "clinical" role doing review. As a Registered Nurse Integrity Clinician, you will be responsible for conducting post service reviews of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding.
This position is a contract role, with a duration of 4 months, with the possibility of extension.
Pay range: $40.00/hr.
Location: Anywhere in US, if candidate can work within Pacific Time Zone hours.
Equipment: Computer will be provided, must be directly connected to modem.
Key Responsibilities for RN Integrity Clinician:
- This is a medical criteria review position.
- Ability to read and interpret medical records and patient data and communicate effectively with clinical and non-clinical staff.
- Evaluating medical necessity of short-length inpatient hospital stays.
- Conducts subjective reviews of patient medical records.
- Evaluates medical records against MCG (Milliman Care Group) guidelines regarding acute in-patient criteria.
- Use of critical thinking skills to produce high quality audit reviews.
- Applies nursing expertise to ensure compliance with medical and reimbursement policies and/or guidelines and accepted standards of care.
- Ensures that medical records and other documentation requirements follow federal regulations, company policies and industry standards.
- Serves members and providers by performing reviews of claims along with corresponding medical records (when required) to ensure appropriate payment of claims.
- Consults with physician advisors to ensure clinically appropriate determinations.
- Collaborates with other departments to resolve member or provider claims adjudication issues.
- Responds in writing or telephonically to internal and external customers in a professional and diplomatic manner while protecting confidentiality of sensitive documents and issues.
- Knowledge of medical and surgical procedures and other healthcare practices.
- Competency to apply clinical expertise to ensure compliance with medical policies and/or reimbursement policies.
- Possesses a working knowledge of clinical coding applications, as appropriate.
- Participate in courses and continuing education to maintain licensure and applicable certifications.
Requirements RN Integrity Clinician:
- Must have 3 years of clinical experience in an acute inpatient hospital setting is required.
- Associates or bachelor’s degree in Healthcare and 3 years of experience in a clinical setting, health insurance, coding/claims review, case management or equivalent combination of education and experience.
- Register Nurse (RN) license (must have a current unrestricted RN license)
- Excellent computer and technology skills and proficiency working software programs (i.e. Microsoft Word, Excel, and PowerPoint);
- Strong verbal, written and interpersonal communication and customer service skills.
- Strong research, analytical, math and problem-solving skills.
**We are unable to accommodate corp. to corp. candidates**
About Motus Recruiting and Staffing, Inc:
Founded in 2006, Motus is an award-winning recruiting and staffing firm in the Pacific Northwest, specializing in professional services and technology solutions. We are a group of people who not only recognize the importance of representation, but actively fight for diversity, equity, and inclusion in the recruitment process. Our goal is to educate organizations on the importance of DEI when hiring, promoting, and supporting diverse employees. We are calling organizations to demonstrate their commitment to DEI by being intentional about who they hire.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability or protected veteran status.