Perform comprehensive medical record and claims reviews to make payment determinations for Medicare Diagnosis Related Group (DRG) claims. Utilize coding principles and electronic databases to ensure departmental compliance with quality management systems.
Empower AI Inc.
6 Remote Job Openings at Empower AI Inc.
The specialist is responsible for analyzing, validating, and categorizing appeals hearings documentation and performing data entry into the CMS tracking system. Additionally, they coordinate and schedule hearings with Hearing Officers, legal professionals, and other stakeholders.
Perform comprehensive medical record and claims reviews to make payment determinations for Medicare Part A services. Utilize coding principles and electronic databases to ensure departmental compliance with quality and ISO standards.
Perform comprehensive medical record and claims reviews to make payment determinations for Medicare Durable Medical Equipment. Utilize coding principles and electronic databases to ensure compliance with quality and production standards.
Maintain and manage Active Directory Group Policies for Windows workstations and applications while ensuring security hardening compliance. Provide Tier 3 technical support for hardware and software issues and manage BitLocker encryption for GSA PCs.
The Medical Review Specialist V will review and analyze Medicare claims to make payment determinations based on coverage and coding. Responsibilities include conducting medical record claims reviews, analyzing suspected fraudulent billing practices, and completing summary reports for the Department of Justice.
