Nurse Work from Home Jobs | Medical Jobs for Freshers Applying 2021

Piper Life Sciences is actively seeking a Medical Review Analyst to join a major healthcare organization in Raleigh/Durham. Positions are currently remote and work traditional hours but candidates must be within 50 miles of the Durham campus.

Responsibilities of the Medical Review Analyst:

• Review records/charts for pre-existing, medical necessity, benefits eligibility, or adequate reimbursement funds for claims by utilizing clinical experience.
• Follow up root cause and recommend solutions. Communicate findings regarding root cause with necessary stakeholders.
• Review claims submitted by both medical personnel and members by utilizing clinical knowledge. Determine medical necessity of treatment and refer cases accordingly.
• Identify and document inappropriate billing or utilization trends.
• Keep members and providers informed about the status of claims and medical reasoning behind next steps.

Qualifications of the Medical Review Analyst:

• RN/LPN NC license
• Strong computer skills
• 3+ years of hands on clinical experience in a hospital or other clinical setting
• Medical billing experience not required, but nice to have