Pennsylvania Licensed Care Management Coordinator

A company is looking for a Care Management Coordinator, Medical Review.

Key Responsibilities

Conduct post-service reviews on medical claims to ensure compliance with medical policies and guidelines

Analyze claims during the adjudication process and provide direction for claims processing

Collaborate with various departments and summarize analyses for management reporting

Required Qualifications

RN license; BSN preferred

3-5 years of experience with medical criteria reviews

Strong knowledge of ICD-10, HCPCS, and CPT coding / billing

Claims auditing experience is a plus

Proficiency in Microsoft Office Suite and ability to learn new systems