Job Responsibilities : Remote Medical Review Analyst
Salary : $55,000 – $65,000 a year
Company : Piper Companies
Location : RemoteCA
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