Fort Worth, Texas is nicknamed "Cowtown" for its deep roots in the cattle ranching industry. Fort Worth is home to the celebrated Stockyards National Historic District. Fort Worth is home to several art museums, beautiful public spaces including the oasis-like Water Garden, entertainment venues like Bass Performance Hall, and shopping galore in areas like Sundance Square. Whether you are looking to relocate or are a current resident, job opportunities in Fort Worth are abundant.
On Time Talent Solutions is seeking an enthusiastic Registered Nursewith previous experience in facility clinical investigation!
Facility Clinical Investigator Responsibilities:
Performs clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
Investigates, reviews, and provides clinical and/or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
Performs clinical coverage review of claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review
Maintains and manages daily case review assignments, with a high emphasis on quality
Provides clinical support and expertise to the other investigative and analytical areas
Will be working in a high volume production environment that is matrix drive
Facility Clinical Investigator Requirements:
Unrestricted RN (registered nurse)
Managed care and Healthcare claims experience
Investigation and / or auditing experience
Knowledge of health insurance business, industry terminology, and regulatory guidelines
1+ year of medical coding experience
Must be competent in ICD - 10 and PCS
RHIT (registered health information technician), RHIA (registered health information administrator), CDIP (certified documentation improvement practitioner) OR current certified facility in - patient coder
1+ year of DRG coding or DRG auditing experience (facility only)
Numbers & Facts
Location
Fort Worth, Texas
Skills
Adjudicationunmatched
Analysis Skillsunmatched
Auditingunmatched
Billingunmatched
Claims Processingunmatched
Clinical Facilitiesunmatched
Clinical Informationunmatched
Clinical Supportunmatched
Clinical Validationunmatched
Code Reviewsunmatched
Documentationunmatched
Drug Developmentunmatched
Health Insuranceunmatched
ICD-10unmatched
Managed Careunmatched
Medical Codingunmatched
Production Systemsunmatched
Production Volumeunmatched
Registered Health Information Administrator (RHIA)unmatched
Registered Health Information Technician (RHIT)unmatched
Registered Nurse (RN)unmatched
Regulationsunmatched
Reimbursementunmatched
Time Managementunmatched
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