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

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

Click Here : Apply Now

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