Medicare Medical Review RN (Medical Reviewer III)

The Medicare Medical Review RN (Medical Reviewer III) will primarily be responsible for conducting clinical reviews of medical records during fraud investigations and other program integrity initiatives. This position applies Medicare and Medicaid guidelines in making clinical determinations as to the appropriateness of payment coverage. In this position, you will be a critical contributor to meeting CoventBridge Group's objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse. Responsibilities include reviewing claims data, utilizing medical terminology and coding knowledge, coordinating investigative reports, and providing training to staff. Requirements include experience as a government contractor, knowledge of ICD-10-CM/CPT coding, and familiarity with Medicare coverage guidelines.