Medicare Claims Review RN — CERT & Coding Expert

Catapult Consultants, LLC; Richmond (VA); On-site; USD 65,000 - 85,000; Full time

Job summary

Catapult Consultants, LLC is seeking a Registered Nurse to support the Medicare Comprehensive Error Rate Testing (CERT) program. This role involves reviewing claim documentation and medical records to assess payment qualifications and compliance with Medicare guidelines.

The ideal candidate will have an active RN license, significant experience in coding and Medicare reimbursement, and familiarity with standard coding conventions. This full-time position is Monday to Friday.

Catapult Consultants values diversity and does not discriminate in employment opportunities.

Qualifications

• 5 years of full-time work experience.
• 3 to 5 years of experience in coding.
• At least 2 years of experience in inpatient, acute care coding for Medicare reimbursement.

Responsibilities

• Review claim documentation related to the CMS CERT program.
• Determine whether Medicare services qualify for coverage and payment.
• Assess compliance with Medicare coding and billing rules.

Skills

Registered Nurse (RN) with an active license

Knowledge of standard coding conventions

Familiarity with Medicare guidelines

Detail-oriented

Ability to work independently

Education

Associate’s, Diploma or Bachelor’s degree in Nursing

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Catapult Consultants is a global, professional services and management consulting company specializing in business, analytical and information systems solutions. We support mission-critical programs in the Intelligence Community and Defense and Civilian sectors. Our health care soultions division is currently looking for Registered Nurse to support our transplant program quality assessment and performance improvement program. For more information about us go to www.catapultconsultants.com .

Job Description

This position provides support for a federal government project to review Medicare documentation as part of the Centers for Medicare & Medicaid Services’ (CMS) Comprehensive Error Rate Testing (CERT) program to measure improper payments in the Medicare fee-for-service (FFS) program.

• Full-Time, Monday – Friday
• Two open positions located in Richmond, Virginia

Responsibilities:

• Review claim documentation and associated medical records related to the CMS CERT program and determine whether Medicare FFS program services qualify for coverage and payment.
• Assess whether claim documentation and associated medical records complies with Medicare coverage, coding and billing rules.
• Compare documentation assessments to those of the Medicare contractor who originally reviewed and paid the claims and note which claims are in “error” if they have been incorrectly billed, paid or processed the services.
• Other duties as assigned

Qualifications

• Registered Nurse (RN) with an active license
• Associate’s, Diploma or Bachelor’s degree in Nursing
• 5 years of full-time work experience
• 3 to 5 years of experience in coding
• At least 2 years of experience in inpatient, acute care coding for Medicare reimbursement and MS-DRG experience
• Knowledge of standard coding conventions, such as DRGs, ICD-9-CM, HCPS and CPT
• Knowledge of Payment methodologies and Medicare guidelines
• Familiarity and understanding of Medicare rules, regulations, policies and procedures
• Familiar with Microsoft Word, Excel and Outlook
• Highly-motivated, detail-oriented, quick learner with a professional demeanor
• Ability to effectively work independently

Additional Information

Catapult Consultants does not discriminate in practices or employment opportunities on the basis of an individual's race, color, national or ethnic origin, religion, age, sex, gender, sexual orientation, marital status, veteran status, disability, or any other proscribed category set forth in federal or state regulations.

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