Medicare Reviewer Specialist

Angeles, Central Luzon, Philippines

Job Openings Medicare Reviewer Specialist

Position Title: Medicare Reviewer Specialist

Salary: 35,000 - 40,000

Reports To: Client Advisor, Client

Primary Relationships: Client Staff

Date: May 2023

Schedule: 9:00 PM to 6:00 AM PHT

Responsibilities:

Conduct audits and reviews of Medicare Plans of Care "485s" to ensure compliance with Medicare regulations and proper standards
Verify the appropriateness, congruency, and accuracy of clinical documentation in relation to the Medicare PDGM billing model and CMS guidelines
Provide recommendations and communicate with clinicians to promote accurate documentation
Support and communicate with all disciplines within the service
Offer customer service, education, and serve as a resource to Medicare Certified Offices regarding CMS guidelines
Maintain regular communication with service offices via email, zoom, or telephone based on their specific needs
Monthly communication with service offices focusing on documentation trends, star ratings, and potential revenue impact
Perform any additional duties as required or requested by the Manager/Director

Requirements:

Active RN license in the United States
Minimum of 2 years of clinical supervision/management experience
Proficient knowledge of home health and Medicare regulations
Excellent organizational, interpersonal, and communication skills
Strong attention to detail and ability to work in a team-oriented, fast-paced environment.
COS-C, HCS-O, or COQS OASIS Certification is a plus
Experience with Medicare, Coder, OASIS Review, Utilization Review, Quality Assurance, Remote, Home Health Coding is beneficial

COmpany Benefits:

Or refer someone