Claims Review Management Nurse

Job Description

Job Description

A-Line Staffing is now hiring Claims Review Management RN in Harrisburg, PA f you are interested in this Claims Review Management Nurse RN position, please contact Alexis at 1586-422-1748 or awordlaw- [email protected]

Job Title: Claims Review Management Nurse RN
Location: Harrisburg, PA Hybrid
Schedule: Monday–Friday | 8:00 AM – 4:00 PM
Job Type: Long-Term Contract

Pay rate: 40.00per hour

Claims Review Management Nurse RN Responsibility

• Provide oversight to projects and processes for support of managerial leadership. Consultant will be assigned to workgroups and project teams. Assignments will consist of a combination of ongoing process responsibilities, standing workgroup participation, and time-limited projects related to the management and operations of all aspects of the Pennsylvania Medicaid program, including but not limited to:
• Evaluation and implementation of system enhancements for provider enrollment, provider inquiry, and medical review;
• Evaluation of current processes and implementation of recommended process improvement;
• Consult with senior staff to outline major operational issues and develop resolutions based on sound data analysis;
• Act as a liaison between the Department of Human Services and external stakeholders (individuals and/or groups);
• Assist in determining if any changes should be made to criteria or regulations to better serve clients;
• Review certain claims, analyze, and process through the payment system;
• Provide operational input for claims processing decisions;
• Assist with coding and procedure code groupings;
• Participate in the yearly coding updates and assist in updating the system according to the reviewed and accepted codes for the PA Medical Assistance Program;

Claims Review Management Nurse RN Requirements

• Possess an active Pennsylvania Registered Nurse license;
• Possess a documented work history of five (5) or more years of experience with claims review/coding or processing; be familiar with HCPCS II, CPT, or Dental coding;
• Possess computer skills, including familiarity with Microsoft Office programs, including Microsoft Excel/Word/PowerPoint ;
• Possess prior experience with PROMISe or similar claims processing system;
• Possess prior experience with Medicare or Medical Assistance coding rules;
• Possess prior experience with researching medical policies, out of state comparison, participation in studies or projects.

If you think this Claims Review Management Nurse RN position is a good fit for you, please reach out to me - feel free to call, e-mail, or apply to this posting!

For more information, please contact
Alexis
Staffing Manager