Offer summary
Qualifications:
2 years with BS/BA or 6 years experience without degree, 2 years in medical field as RN or clinician, Current active nursing license, Strong investigative and communication skills, Strong PC knowledge.Key responsabilities:
- Conduct medical record reviews for claims
- Apply clinical judgment to payment decisions
- Research and identify potential fraud cases
- Develop cases for administrative actions
- Prepare reports and correspondence