Machinify

Machinify

Medical Review Nurse - SNF/MDS Auditor

Remote - US · Director

Sponsorship not specifiedDetected 14 days ago
ExcelAuditingICD-10CommunicationMicrosoft OfficeClaims Management

About the role

  • As a MR Nurse, you will join a team of experienced medical auditors performing retrospective and prepayment audits on claims for Government and Commercial Payers.
  • You will work remotely in a fast-paced and dynamic environment and be part of a multi-location team.

Responsibilities

  • Document all findings referencing the appropriate policies and rules.
  • Support audit findings during the appeals process if requested.
  • Ability to maintain high quality work while meeting strict deadlines.
  • Ability to manage multiple tasks including desk audits and claims review.

Requirements

  • Active unrestricted RN license in good standing, is required.
  • One (1) or more years' experience with MDS/ RAI process.
  • Other duties as required to meet business needs.
  • Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload.

Nice to have

  • Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.
  • Strong preference for Understanding and in-depth comprehension of PDPM HIPPS codes including HIPPS Clinical Categories and the components that comprise the HIPPS categories.
  • Knowledge of RUG and LOC commercial payors preferred but not required.
  • 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 and deep knowledge of ICD-9, ICD-10, HCPCS coding.
  • Knowledge of PDPM payment Items contributing to payment methodologies.
  • 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

  • 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.
  • 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.
  • This role requires specific MDS experience, so if you do not have that experience then please consider applying for one of our other Medical Review Nurse roles, which may be a better fit for you.
  • Auditing claims for medically appropriate services provided in skilled nursing facility 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.

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
Apply directly at Machinify →Create a free account for alerts like thisView Machinify immigration profile

This listing is sourced directly from Machinify's careers page and normalized into a canonical job model.