Job details
Salary $16.08 - $26.45 an hour job type full-time
Full job description
* position is eligible for remote / work from home opportunity *
Department: dme medical review
Telecommuting: yes
Paygrade: n13
Job title
Medical review analyst
Job summary
The medical review analyst is responsible for the completion and development of medical review reporting requirements to assist in the development of innovations and efficiencies towards the medical review workloadsThis position manages all case management activities for effective progressive corrective action.
Key performance indicators
Excellent multi-tasking skills
Prioritization and organization skills
Strong analytical skills
Essential functions
Key duties/responsibilities/accountabilities
Conducts data analysis of reports to determine edits and program effectiveness and acts as the medical review liaison during times of audit activities
Follows the progressive corrective action (pca) principles set forth in the internet only manual (iom) and ensures all statement of work (sow) requirements are being met
Reviews and analyzes analytics to determine high risk services or providers
Takes progressive corrective actions based on the follow-up data analysis to improve provider error rates
Coordinates activities, updates process, maintains pts/cases, and conducts reporting for medical review case management
Develops, maintains, and analyzes statistical reports for very edit to determine effectiveness
Coordinates meetings with case managers, data analysts, and other medical review staff
Evaluates data analysis results to determine actions needed
Submits appropriate system action memos (sams) and case management activities
Trains medical review staff on case management activities
Collaborates with other teams and entitles such as data analysis staff, zpic, medical directors, and system support staff
Assist provider outreach and education (poe) with data analysis and reporting needs
Responsible for medical review reporting and supports the medical review workload and processes
Assists in internal and external audit activities
Contributes positively to a work environment that is flexible, adaptable, and team based
Non-essential duties and functions
Other duties as assigned
Trains new staff
Reviews centers for medicare and medicaid services (cms) correspondence pertaining to medical review and identifies updates needed
Minimum qualifications
2 years` college education in business, medical administration, case management or related field or 2 years of medicare experience
Advanced pc skills including proficiency in microsoft office suite applications (word, excel, outlook, and powerpoint)
Strong verbal and written communication skills
In-depth knowledge and experience with medical review program requirements, processing systems, and edits and case management activities
Experience in reporting and analyzing data
Preferred qualifications
Above requirements and the following:
Experience working with medical review and case management activities
Experience working with system edits and analyzing and interpreting data
Environment and cognitive/physical demands
Office environment
Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
Requires prolonged sitting and telephone use
Requires the use of office equipment such as computer terminals, telephones, copiers and printers
Infrequent lifting to 15ounds
Infrequent stooping
Segregation of duties
Every employee is responsible to perform their duties and responsibilities in accordance with noridian values, policies and procedures, including but not limited to: segregation of duties principles, hipaa, security and privacy, cms requirements, the noridian compliance program and any other applicable laws, rules and regulations.
Statement of other duties
This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functionsEmployees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.
Total rewards package:
Health, dental and vision insurance, voluntary insurance plans, health savings and flexible spending accounts, 401k and company match, company-paid life insurance, education assistance program, paid sick leave, paid holidays, increasing pto accrual plan, medical/parental/disability leave, workers compensation, retiree benefits, severance package, employee assistance program, financial and health wellness benefits, casual dress, open office setting, and online learning system.
Cms access compliance and regulation contingency statement
Some positions require compliance with (i) federal and agency specific regulations and related clauses included in noridian`s prime contracts with the government, (ii) background checks, and (iii) eligibility for a government-issued identification card.
Equal employment opportunity
Equal opportunity employer of minorities, females, protected veterans, and individuals with disabilities as well as sexual orientation or gender identity.
Other information
Job posting policy 6.05: new employees with noridian healthcare solutions will be eligible to apply for positions within their assigned department after successfully completing a 90-day reviewFor positions outside their department, they must attain a minimum of six months of service before they can apply.
Notice to colorado applicants:
Per colorado’s equal pay transparency rules act, below is the salary range for potential new hires that will be
Working/residing in the state of colorado.
Colorado salary range: $16.08 - $26.45
Other compensation: incentive plan
This job will be closed 10/12/2021 at 8:00am cstNo further applications will be considered.
Equal opportunity employer/protected veterans/individuals with disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicantHowever, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information41 cfr 60-1.35(c)
