Nurse Reviewer Peraton · Remote US
$51k - $82kQuickCruit, Inc.
Brooklyn, NY
- Remote job
- Nurse ReviewerPeraton · Remote USTailor My ResumeStart free. No credit card.### ResponsibilitiesSafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.We are looking to add a Nurse Reviewer to our SGS team of talented professionals.The position requires the individual to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions. Responsibilities may include additional research on medical claims data and other sources of information to identify problems, review sophisticated data model output, and utilize a variety of tools to detect situations of potential fraud and to support the ongoing fraud investigations and requests for information. The incumbent will use a variety of tools to identify and develop cases for future administrative action, including referral to law enforcement, education, over payment recovery. Will work with external agencies to develop cases and corrective actions as well as respond to requests for data and support.* Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government* Research regulations and cite violations.* Conduct self-directed research to uncover problems in Medicare payments made to institutional and non-institutional providers.* Make claim payment decisions based on clinical knowledge* Telework available from anywhere in the United States### Qualifications* 5 years with BS/BA; 3 years with MS/MA; 0 years with PhD* Experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity.* Current nursing license.* Strong investigative skills* Strong communication and organization skills* Strong PC knowledge and skills* US. citizenship requiredPosted4 days agoJob TypeFull-timeSalary$51,000 – $82,000 USDLocation* Remote US
- J-18808-Ljbffr QuickCruit, Inc.
Vacancy posted 2 days ago
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