Facility Clinical Investigator - Fort Worth

Company : On Time Talent Solutions

Job Type : Full Time

Fort Worth, United States

Job Description - Facility Clinical Investigator - Fort Worth

Facility Clinical Investigator - Registered Nurse

Fort Worth, Texas

Fort Worth, Texas is nicknamed "Cowtown" for its deep roots in the cattle ranching industry. Fort Worth is home to the celebrated Stockyards National Historic District. Fort Worth is home to several art museums, beautiful public spaces including the oasis-like Water Garden, entertainment venues like Bass Performance Hall, and shopping galore in areas like Sundance Square. Whether you are looking to relocate or are a current resident, job opportunities in Fort Worth are abundant.

On Time Talent Solutions is seeking an enthusiastic Registered Nursewith previous experience in facility clinical investigation!

Facility Clinical Investigator Responsibilities:

Performs clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing

Investigates, reviews, and provides clinical and/or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information

Performs clinical coverage review of claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns

Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review

Maintains and manages daily case review assignments, with a high emphasis on quality

Provides clinical support and expertise to the other investigative and analytical areas

Will be working in a high volume production environment that is matrix drive

Facility Clinical Investigator Requirements:

Unrestricted RN (registered nurse)

Managed care and Healthcare claims experience

Investigation and / or auditing experience

Knowledge of health insurance business, industry terminology, and regulatory guidelines

1+ year of medical coding experience

Must be competent in ICD - 10 and PCS

RHIT (registered health information technician), RHIA (registered health information administrator), CDIP (certified documentation improvement practitioner) OR current certified facility in - patient coder

1+ year of DRG coding or DRG auditing experience (facility only)

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Facility Clinical Investigator - Fort Worth

Job Description - Facility Clinical Investigator - Fort Worth

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