Job Responsibilities : Medical Review Analyst – Remote
Salary : $69000 per year
Company : Piper Companies
Location : Remote US
Responsibilities of the Medical Review Analyst:
Analyze records and utilize clinical experience to determine pre-existing, medical necessity, benefit eligibility and/or appropriate reimbursement for claims and/or products.
Responsible for identifying, documenting, and escalating system and process issues. If issues arise, determine root cause and recommend solutions and complete correction.
Review claims submitted by medical personnel and members by utilizing clinical knowledge. Determine medical necessity or treatment and refer cases accordingly.
Monitor billing and document inappropriate usage or utilization trends.
Maintain communication for members and providers about the status of their claims and medical reasoning behind decisions.
Qualifications of the Medical Review Analyst:
RN/LPN North Carolina (NC) license
Strong computer skills
3+ years of hands on clinical experience
Medical billing experience preferred, but not required
Compensation of the Medical Review Analyst:
Salary: based on relevant experience
Comprehensive Benefits: Cigna Healthcare, MetLife Dental, VSP Vision, 401K