Nurse Reviewer | Medical Coding, Billing, Claim, Clinical Expertise | @ Automobile company

Job Description

Our reputed MNC Client is hiring for Nurse Reviewer role:

Shift: 11:30 AM - 8:30 PM

Work Mode: Work From Office (5 days)

Location: Hyderabad

Job Summary:

We are seeking an experienced Nurse Reviewer to conduct in-depth claim reviews based on medical guidelines, clinical criteria, and billing rules. The ideal candidate will have a strong understanding of medical coding, clinical experience, and excellent communication skills.

Key Responsibilities:

- Conduct claim reviews to identify areas with savings potential

- Review and validate charges against medical documentation

- Contact medical providers to resolve billing inconsistencies

- Manage claims reports and prioritize according to client stipulations

- Maintain production metrics and quality assurance scores

Requirements:

- Current RN/LPN license

- Varied clinical experience (Med/Surgery, ICU, Emergency Medicine)

- Understanding of hospital coding and billing rules

- Experience in medical claims review and audit techniques

- Excellent communication and organizational skills

Preferred Qualifications:

- Background as a nurse or doctor

- 4-5 years of hands-on experience in medical coding

- Strong understanding of medical coding related to post-operative care, joint replacement, spinal surgery, and cardiac surgery procedures

Warm Regards,   

Gayatri Kumari 

Email Id: ga****i@v3*******g.in

V3 Staffing Solutions

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Keyskills:   Medical coding Clinical reviewer medical claims Medical Billing medical record review medical claims reviewer Nurse reviewer reimbursement policies