Job Closed
This listing is no longer active.
Empower AI (formerly NCI) elevates public sector teams with the power of AI, to ensure America’s missions are met.
Medical Reviewer III – Medicare/DME
Location
United States
Posted
90 days ago
Salary
0
Seniority
Senior
Job Description
Medical Reviewer III – Medicare/DME
Empower AI
• Perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment (DME). • Perform projects or duties as assigned as a Medical Review Specialist. • Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles. • Utilize electronic health information imaging and input medical review decisions by electronic database module. • Utilize internet and intranet sources for policy verification. • Utilize Microsoft Office suite and other software templates as associated source input for claims review. • Make clinical judgment decisions based on clinical experience when applicable. • Meeting quality and production standards.
Job Requirements
- Registered Nurse obtained by either a Bachelor's degree – OR - Associate's degree – OR - Diploma in Nursing.
- At least four (4) years claims knowledge either from billing, reviewing, or processing of Durable Medical Equipment.
- At least three (3) years clinical experience as a Registered Nurse.
- Minimum two (2) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for Physician Office practices, Laboratory, and Ambulance Services.
- Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
- Ability to keep sensitive and confidential material private.
- Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI).
Benefits
- Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs.
- Comprehensive medical record review and claims review for Medicare Durable Medical Equipment (DME).
- Responsible for review of Medicare DME claims.
- Complete projects or duties as assigned by the Medical Review Lead Specialist.
Related Guides
Related Categories
Related Job Pages
More Medical Reviewer Jobs
Physician Reviewers - Hematology/Medical Oncology (Stem Cell Transplant )
Dane Street, LLCA fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
This telework opportunity allows you to customize your schedule and caseload within the week while maintaining client-mandated turnaround times. Our reviewers are compensated on a per-case basis as a 1099 independent contractor Physician Specialty: Hematology/Medical Oncology - Stem cell transplant specialists JOB SUMMARY Utilizes clinical expertise, and reviews insurance appeals, and prospective and retrospective claims. The physician reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care. MAJOR DUTIES AND RESPONSIBILITIES: - Reviews all medical records and addresses each question posed by the client utilizing client-specific criteria or other nationally recognized evidence-based criteria - Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision - Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes - Provides copies of any criteria utilized in a review with the report on time - Returns cases on or before the due date and time - Makes telephone calls as mandated by the state and/or client specifics - Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job - Attends all required orientation and training - Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits PLEASE BE AWARE: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.
Linkedin: https://www.linkedin.com/company/mindfriend Location: 100% Remote Job Type: Full-time / Part-time About Mind Friend At Mind Friend, we believe that accessing quality mental healthcare should be as simple as reaching out to a good friend. We are a fast-growing telehealth platform dedicated to providing compassionate, accessible, and effective psychological support to our clients from the comfort of their homes. We are looking for a highly empathetic and organized Telehealth Psychologist Assistant to join our fully remote team and support our licensed psychologists in delivering top-tier care. The Role As a Telehealth Psychologist Assistant, you will be the backbone of our clinical operations. You will act as the first point of contact for our clients, ensuring a smooth and welcoming virtual experience, while providing vital administrative and clinical support to our psychologists. If you are passionate about mental health and want to gain hands-on experience in the telehealth industry, this is the perfect role for you. Key Responsibilities - Patient Onboarding: Guide new clients through the intake process, ensuring all preliminary paperwork, consent forms, and assessments are completed prior to their first session. - Schedule Management: Coordinate calendars, schedule appointments, and manage cancellations or rescheduling for multiple psychologists. - Virtual Room Support: Act as the technical liaison for clients, helping them troubleshoot any video, audio, or platform connectivity issues before or during their sessions. - Clinical Administration: Assist psychologists with preparing session materials, organizing electronic health records (EHR), and proofreading non-clinical documentation. - Patient Communication: Respond to patient inquiries via email and secure messaging with warmth, professionalism, and promptness. - Compliance: Maintain strict confidentiality and ensure all tasks are performed in compliance with HIPAA and other patient privacy regulations.
Community Health Worker
Texas Tech UniversityFounded in 1923, Texas Tech University is a public research university. Located in Lubbock, Texas, Texas Tech University is the leading institution of the Texas
Plan and coordinate community outreach activities, maintain program records, and build relationships with community partners while providing education and support to clients and participants in health-related initiatives.
Description TOXICOLOGIST To support ICF’s dynamic growth and expanding client base, we are seeking a Toxicologist to work in our Health Science Portfolio. This group of 100+ science professionals provide toxicology, hazard assessment, epidemiology, risk assessment, exposure assessment, environmental modeling, and related support that addresses the full spectrum of potentially hazardous agents, including chemicals and microbes. We specialize in identifying and quantifying the effects of environmental pollutants, such as metals, pesticides, and volatile organic compounds, on human health and the environment. The Toxicologist’s project work would support federal agencies (such as U.S. EPA and NIEHS) in conducting and reporting the results of hazard studies and supporting risk assessments of environmental pollutants and microbes. The position can be located remotely, although preference is for a candidate to be located in Durham, NC. Key Responsibilities: - Project and technical support of activities on multiple projects concurrently involving toxicology data, mechanistic data, systematic literature reviews, and risk assessment. - Support of and project leadership in literature reviews of carcinogens and other substances for potentially hazardous agents, including: - screening available studies for relevance to a research question, - extracting relevant study data, - evaluating study design and the risk of bias for included studies, - synthesizing evidence to reach a hazard conclusion, - performing quantitative analyses to develop dose-response relationships and meta-analyses, and - documenting methods, assumptions, conclusions, and key data gaps in a report - Task and project management - Interaction and correspondence with clients - Review of work produced by others - Development of technical publications and guidance, presentations at conferences, and proposal sections - Mentoring and training other technical staff Basic Qualifications: - Graduate degree or equivalent in toxicology, pharmacology, environmental science, or related subject. - Minimum one year of experience with government programs (preferably U.S. EPA or NIEHS) Professional Skills You Will Use: - Proactive and problem-solving approach to challenges - Excellent organizational skills and attention to detail - Ability to prioritize, multi-task, and work under strict deadlines in a fast-paced environment. - Experience with project management and staff leadership - Demonstrated ability to formulate and execute technical approaches to solving scientific questions Working at ICF ICF is a global advisory and technology services provider, but we’re not your typical consultants. We combine unmatched expertise with cutting-edge technology to help clients solve their most complex challenges, navigate change, and shape the future. We can only solve the world's toughest challenges by building a workplace that allows everyone to thrive. We are an equal opportunity employer. Together, our employees are empowered to share their expertise and collaborate with others to achieve personal and professional goals. For more information, please read our EEO policy. We will consider for employment qualified applicants with arrest and conviction records. Reasonable Accommodations are available, including, but not limited to, for disabled veterans, individuals with disabilities, and individuals with sincerely held religious beliefs, in all phases of the application and employment process. To request an accommodation, please email Candidateaccommodation@icf.com and we will be happy to assist. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodations. Read more about workplace discrimination rights or our benefit offerings which are included in the Transparency in (Benefits) Coverage Act. Candidate AI Usage Policy At ICF, we are committed to ensuring a fair interview process for all candidates based on their own skills and knowledge. As part of this commitment, the use of artificial intelligence (AI) tools to generate or assist with responses during interviews (whether in-person or virtual) is not permitted. This policy is in place to maintain the integrity and authenticity of the interview process. However, we understand that some candidates may require accommodation that involves the use of AI. If such an accommodation is needed, candidates are instructed to contact us in advance at candidateaccommodation@icf.com. We are dedicated to providing the necessary support to ensure that all candidates have an equal opportunity to succeed. Pay Range - There are multiple factors that are considered in determining final pay for a position, including, but not limited to, relevant work experience, skills, certifications and competencies that align to the specified role, geographic location, education and certifications as well as contract provisions regarding labor categories that are specific to the position. The pay range for this position based on full-time employment is: $89,222.00 - $151,678.00 N Carolina Remote Office (NC99)

