Medical Claims Clinical Review Nurse
ADP
1 day ago
Full-time
Remote
United States
$36 - $48 USD hourly
Benefits:
- 401(k)
- 401(k) matching
- Company parties
- Dental insurance
- Employee discounts
- Health insurance
- Opportunity for advancement
- Paid time off
- Parental leave
- Savings bank
- Training & development
- Vision insurance
- Wellness resources
About the Role:
Join MedPOINT Management as a Medical Claims Clinical Review Nurse in Sherman Oaks, CA, where you'll play a crucial role in ensuring the quality and accuracy of medical claims. This is an exciting opportunity to work in a dynamic environment that values clinical expertise and attention to detail.
Responsibilities:
- Conduct thorough clinical reviews of medical claims to ensure compliance with policies and regulations.
- Collaborate with healthcare providers to clarify information and resolve discrepancies.
- Utilize clinical knowledge to assess the medical necessity of services rendered.
- Document findings and recommendations clearly and accurately in the claims management system.
- Participate in training and development initiatives to enhance team performance.
- Stay updated on industry trends, regulations, and best practices related to medical claims.
- Provide support and guidance to claims processing teams as needed.
- Assist in the development of clinical review policies and procedures.
Requirements:
- Registered Nurse (RN) license in California is required.
- Minimum of 3 years of clinical nursing experience, preferably in a hospital or healthcare setting.
- Experience in medical claims review or utilization management is a plus.
- Strong analytical skills with attention to detail and accuracy.
- Excellent communication and interpersonal skills.
- Ability to work independently and manage multiple priorities effectively.
- Proficiency in electronic medical record (EMR) systems and claims management software.
- Commitment to continuous professional development and improvement.
About Us:
MedPOINT Management has been a leader in the healthcare management industry for over a decade. Our commitment to excellence and patient-centered care has earned us the trust of our clients and the loyalty of our employees. Join us and be part of a team that makes a difference in the lives of patients every day.
This is a remote position.
Compensation: $36.00 - $48.00 per hour