Job Description

Nurse Reviewer

Job Purpose: The Nurse Reviewer reviews appeals against medical records to ensure accuracy and thoroughness. All appeals produced must accurately reflect what is documented in patients' medical records.

Duties & Responsibilities:

• Maintain the integrity of information in each appeal produced by the Firm.
• Review a high volume of written appeals to ensure information is medically accurate.
• Provide clinical strength ratings based on application of clinical practice guidelines.
• Be able to facilitate dialogue between Nurse Reviewer and Appeal Writers.
• Other duties as assigned.

Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

Understand and comply with Information Security and HIPAA policies and procedures at all times.

Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties.

Qualifications:

• 4-year degree or work equivalency required.
• Must be a Registered Nurse with clinical experience.
• 1-2 years of direct appeal writing or appeal review experience.
• Experienced in medical chart review.
• 3-5 years of hospital nursing experience.
• Proficiency in Microsoft Office Suite.
• Strong interpersonal skills, ability to communicate well at all levels of the organization.
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses.
• High level of integrity and dependability with a strong sense of urgency and results oriented.
• Excellent written and verbal communication skills required.
• Gracious and welcoming personality for customer service interaction.

Working Conditions:

Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.

Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.

Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.

Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Minimum Salary: 70000 Maximum Salary: 75000 Salary Unit: Yearly

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