Clinical Medical Reviewer

Licenses/Certifications: RN Registered Nurse State Licensure And/or Compact State Licensure RNVA DC and or MD Upon Hire Req
Essential Functions:

35% Receives researches reviews and analyzes professional and institutional claims using critical thinking nursing clinical judgment and corporate/medical policies for claims processing and/or adjudication Performs highlevel research on topics identified as actual or potential medical policies. Assesses and communicates impact of information on medical policy.
25% Provides pricing of procedure codes which require individual consideration or are listed as not otherwise classified in CPT manual. Interprets the descriptive or medical information utilizing the CPT and HCPCS manuals. Keeps uptodate on coding rules and standards.
25% Participates in medical policy meetings nurses forums and review sessions with Medical and Dental directors special projects and task forces committees as assigned.
15% Performs medical underwriting and risk assessment by reviewing applications of potential subscribers as well as any appropriate medical records.

Thanks & Regards

LAXMAN
KMM Technologies Inc.
Tel: (240)Email: