Medical Claims Reviewer, 6 Month Contract (Remote)
Core
Conduct medical reviews by comparing End Stage Renal Disease (ESRD) patient medical records against data submitted to CMS EQRS and CDC NHSN to identify and classify discrepancies.
Role type
Medical Claims Reviewer (RN)
Builds
Accurate quality reporting for CMS and CDC
Domain
Healthcare / End Stage Renal Disease / Medical Compliance
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
ESRD clinical experience, medical record review, data validation, discrepancy classification, quality control, Microsoft Office
Preferred skills
Dialysis management, managed care, home health, rehabilitation, medical-surgical settings
Technologies
CMS EQRS, CDC NHSN, Microsoft Office
Responsibilities
Compare medical record documentation to EQRS and NHSN data; Determine and classify discrepancies based on error type and severity; Participate in quality control activities; Assist with special projects as assigned
Seniority
Mid-level, hands-on IC