Medical Reviewer (1099 Contract) (Remote)
Core
Review home health pre-claim packages to determine Medicare coverage, coding, and payment compliance.
Role type
Clinical medical reviewer (home health)
Builds
Clinical review decisions and documentation for Medicare claims
Domain
Healthcare + Medicare compliance
Required skills
Active unrestricted RN license, 2+ years clinical experience, 2+ years home health/quality assurance/utilization review experience, ICD coding proficiency
Preferred skills
OASIS experience, Medicare Conditions of Participation knowledge, MAC/RCD/CMS program integrity experience
Responsibilities
Review PCR packages for compliance, document review outcomes with clinical rationale, engage providers for clarification, escalate fraud concerns, maintain 98% accuracy and complete QA sessions
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