State Licensed Medical Reviewer
Company: VirtualVocations
Location: Jackson Heights
Posted on: February 5, 2025
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Job Description:
A company is looking for an Independent Medical Reviewer -
Medical Necessity.
Key Responsibilities
Conduct in-depth medical record reviews for revenue recoupment
opportunities
Compose well-written appeal arguments based on clinical evidence
and coding guidelines
Provide root cause analyses and performance improvement
recommendations to clients
Required Qualifications, Training, and Education
Graduate of an accredited Nursing or Medical Discipline program
with appropriate licensure (RN, NP, MD, etc.)
At least three years of clinical bedside experience required
Knowledge of CMS rules/regulations and third-party payer
requirements
Familiarity with evidence-based inpatient guidelines and
criteria
ECFMG certification preferred for Foreign Medical Graduates (if
applicable)
Keywords: VirtualVocations, Scranton , State Licensed Medical Reviewer, Healthcare , Jackson Heights, Pennsylvania
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