Medical Records Review Nurse | Nurse & Healthcare Jobs in Long Beach | Nurse Jobs

DLT MEDICAL STAFFING

Medical Records Review Nurse

Posted on Classifieds for MySpace - 4 weeks ago

Company:: DLT Medical Staffing

Location:: Long Beach, CA

Features & Description

Looking for a Medical Records Review Nurse for IPA in Long Beach, CA. This is a DIRECT HIRE opportunity.

Position Summary:
Resolves, audits, and processes claims for clinically related issues to ensure accuracy of claims payment, supporting the Claims Administration Department. Maintains contact with community hospitals and providers, reviewing, processing, and auditing claims for payment and appropriateness of charges and pursues adjustments as warranted. Requires licensure as a Registered Nurse and at least one year of experience in utilization review or a managed setting. Risk pool handling experience is a requirement.

Screens, audits, and processes claims of specific criteria for appropriate payment. Establishes effective ongoing relationships with community hospitals and providers. Participates in educational, provider relations, and contrcting meetings with providers to address medical claims payment issues. Visits the providers as necessary to compare billed charges to the medical record. Provides support to the Accounting Department in determining financial liability for out-of-plan medical services. Performs special projects, reconciliations, research, and analysis relating to the utilization and cost of medical services. Works closely with various departments to coordinate the flow of information involving payment of medical bills and analyses of financial liability. Ensures compliance with contractual obligations on claims payments. Documents findings and writes follow-up reports. Recommends and implements innovative strategies to retain members, contain medical costs, and improve efficiency

If interested, email resume to ldelatorre@dltmca.com

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