• Bethesda, MD


  • Irreversible.

  • Full-time.

Task Number: R0085819 Medical Evaluation Subject Specialist

Key Function: Produce performance in the consulting profession while support healthcare clients at the leading edge of payer policy initiatives. Act as a topic expert accountable for detailed medical and declares review. Work with a customer’s organization to assist solve obstacles and construct better company procedures. Conduct and assistance audit work as we build procedure options. Fundamental Qualifications: 3 years of experience with medical record and declares knowledge associated to reviewing, processing, and billing 3 years of experience with medical work as a Registered Nurse Experience in working with federal officials, states, and other appropriate stakeholders on government payer issues Understanding of federal healthcare policies and policies consisting of coverage standards and compensation guidelines in making clinical determinations Ability to handle complicated efforts and tasks and develop and comply with rigorous timelines for evaluations

  • Ability to handle a small group
  • Capability to perform research study, manufacture info, and present findings or recommendations
  • Ability to get a security clearance
  • Bachelor’s Degree or BS degree Active RN license in several of the 50 states or the District of Columbia Additional Certifications: Experience in the consulting field
  • Knowledge of insurance declares systems Knowledge of medical terminology and coding differing throughout different health services MA or MS degree in a health-related field Licensed Expert Coder (CPC) or similar designation Clearance:

Applicants picked will undergo a security examination and might need to fulfill eligibility requirements for access to classified info. We’re an EOE that empowers our people-no matter their race, color, religious beliefs, sex, gender identity, sexual orientation, national origin, impairment, veteran status, or other secured characteristic-to fearlessly drive change.

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