Registered Nurse Coder- CPC required
5128 Apache Plume Rd. Benbrook, TX 76109 US
Job Description
The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care. Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc.
Pay Range: $47,061 – $70,236
This is a remote position- contract to hire
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
- Identify the necessity of the review process and communicate any specific issues of concern to the claim’s examiner/client and or direct reporting manager
- Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans
- Completely document work and final conclusions in designated computer program
Adhere to regular and consistent work attendance - Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) and other requirements as outlined in the Employee Handbook
- Responsive to additional Professional Review job duties as assigned by management or determined by legislative changes and/or market changes
- Must be able to communicate concisely and effectively in writing and verbally
- Must have the ability to interface with the claim’s adjusters, attorneys, physicians and their representatives, and advisors/clients, and co-workers
- Must have the ability to effectively promote all Professional Review products with attorneys, claims examiners, customers and management
- Must be computer literate
- Knowledge of worker's compensation claims preferred
- Must maintain current licensure as a Registered Nurse in the state of employment with a minimum of 4 years clinical experience
- A minimum of an Associate Degree in Nursing as well as have a thorough knowledge of both C.P.T. and I.C.D.10 codes is preferred Medical bill auditing experience preferred
- Experience in the clinical areas of O.R., I.C.U., C.C.U., E.R., and orthopedics preferred
- Prospective, concurrent and retrospective utilization review experience preferred
Quick Apply on line or text David at 972-346-0506
Meet Your Recruiter
David McClanahan
Operations Manager
David has been in healthcare recruiting for 2 years, placing candidates in all areas of a Hospital/Clinic. He enjoys building strong relationships with his candidates/clients, while helping fill important assignments in his community. David is originally from Galveston, TX but relocated in 2005 to the DFW area to play Baseball in college. David graduated from Northwood University in 2009 with a BBA. He enjoys watching all of Houston sports team, playing Golf and spending time on the weekend with his family.