Position Details
About this role
This role involves reviewing Medicare Fee-for-Service claims to ensure proper payments and compliance with CMS policies. The reviewer assesses claims, applies healthcare regulations, and documents findings for dispute resolution and quality assurance.
Key Responsibilities
- Perform claims reviews
- Apply Medicare policies
- Ensure compliance with CMS rules
- Document findings for disputes
- Support quality assurance
Technical Overview
The position requires expertise in healthcare claims review, Medicare policies, and healthcare coding standards. Familiarity with CMS guidelines, audit procedures, and healthcare documentation is essential.
Ideal Candidate
The ideal candidate is a mid-level healthcare professional with at least 5 years of experience in medical coding and billing, specifically with Medicare Fee-for-Service claims. They possess certifications from AAPC or AHIMA and have a strong understanding of CMS policies and claims review processes.
Must-Have Skills
Nice-to-Have Skills
Tools & Platforms
Required Skills
Hard Skills
Soft Skills
Certifications
Required
Preferred
Industry & Role
Keywords for Your Resume
Deal Breakers
Lack of Medicare Fee-for-Service experience, No relevant medical coding certification, Less than 3 years of healthcare claims review experience
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