Medical Reviewer
6 days ago
We are seeking a skilled Licensed Practical Nurse (LPN) to join our team as a Medical Reviewer. In this role, you will be responsible for conducting medical reviews and providing support to ensure the timely processing of medical claims.
Responsibilities:
Perform medical claim reviews and make reasonable charge payment determinations;
Monitor process timeliness in accordance with contractor standards;
Authorize medical services within benefit and medical necessity guidelines;
Utilize allocated resources to back up review determinations;
Review interdepartmental requests and medical information;
Conduct high-dollar forecasting research and formulate patient health summaries;
Determine risk via telephone screenings/assessments;
Educate members and their families/caregivers on medical reviews and coverage determinations;
Participate in quality control activities and required training.
Requirements:
A Bachelor's degree in Social Work or a Graduate of an Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing;
2 years of clinical experience;
Active, unrestricted LPN/LVN licensure from the United States and in the state of hire;
Ability to remain in a stationary position and operate a computer;
Excellent customer service, organizational, and analytical skills;
Proficiency in Microsoft Office software;
Ability to handle confidential or sensitive information.
About Ask Staffing:
Ask Staffing is an award-winning technology and professional services recruiting firm servicing Fortune 500 organizations nationally. We connect people with amazing opportunities and celebrate diversity in our inclusive environment.
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