Machinify
Medical Review Nurse - CMS/RAC Auditor, Government Audits
Remote - US
Sponsorship not specifiedDetected 26 days ago
AuditingICD-10Communication
About the role
- Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country.
- As a MR Nurse, you will join a team of experienced medical auditors and coders performing retrospective and prepayment audits on claims for Government Payers.
Responsibilities
- Document all findings referencing the appropriate policies and rules.
- Ability to maintain high quality work while meeting strict deadlines.
- Ability to manage multiple tasks including desk audits and claims review.
Requirements
- Other duties as required to meet business needs.
- Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings.
- Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload
Nice to have
- Active unrestricted RN license in good standing, is required.
- Must not be currently sanctioned or excluded from the Medicare program by the OIG.
- Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting.
- Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.
- RAC certification preferred.
- Equal Employment Opportunity at Machinify
- Machinify is an employment at will employer.
- We participate in E-Verify as required by applicable law.
Skills
- Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual.
- Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding.
- Knowledge of insurance programs program, particularly the coverage and payment rules.
- Excellent written and verbal communication skills.
Compensation
- In accordance with applicable state laws, we do not inquire about salary history during the recruitment process.
Benefits
- We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
- The Medical Review Nurse - CMS / RAC (Government Audits) primarily performs medical claims audit reviews for government clients.
- Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules.
- Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits.
- Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients.
- Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines.
- Interface with and support the Medical Director and cross train in all clinical departments/areas.
- One (1) or more years' experience performing medical records review.
Company info
- You will work remotely in a fast paced and dynamic environment and be part of a multi-location team.
Visa & Work Authorization
- al employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status
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This listing is sourced directly from Machinify's careers page and normalized into a canonical job model.