Medicare Claims Reviewer (LPN) | Coding & Appeals Expert

Federal Hearings and Appeals Services, LLC; Wilkes-Barre (Luzerne County); On-site; USD 68,000 - 75,000; Full time

Job summary

Federal Hearings and Appeals Services, LLC is seeking a Nurse Reviewer LPN in Wilkes-Barre, PA to perform timely review and determination of Medicare-related medical claims, including appeals and prior authorizations. The role requires an active LPN license, at least 1 year of clinical experience, and knowledge of CPT/HCPCS/ICD-10 coding.

On-site work with limited travel may be required. The ideal candidate will have strong analytical, written and verbal skills, and may hold CPC/CCS

Qualifications

• Current, unrestricted State LPN license.
• Minimum 1 year of clinical experience.
• Knowledge of CPT/HCPCS/ICD-10 coding is preferred.
• Professional coding certification preferred.
• Strong analytical, written and oral communication skills.
• Ability to review Medicare regulations and payor guidelines.

Responsibilities

• Provide timely review and determination of medical claims, including prior authorization, appeals, and other types of medical claims.
• Analyze medical records related to case file.
• Review and interpret LCD, NCD policies, and other federal regulations.
• Apply regulatory citations to each claim as it relates to the item.
• Formulate a narrative decision citing applicable documentation.
• Adjudicate claims based on regulations and documentation.
• Maintain licensure in active status as required by state.
• Attend FHAS and client training sessions on site as needed.
• Complete IRR surveys in a timely fashion.
• Maintain a 97% or higher quality score.

Skills

Analytical skills

Written and verbal communication

Team player

Attention to detail

PC proficiency

Education

LPN license

CPC or CCS certification preferred

Job description

Federal Hearings and Appeals Services, LLC is seeking a Nurse Reviewer LPN in Wilkes-Barre, PA to perform timely review and determination of Medicare-related medical claims, including appeals and prior authorizations. The role requires an active LPN license, at least 1 year of clinical experience, and knowledge of CPT/HCPCS/ICD-10 coding.

On-site work with limited travel may be required. The ideal candidate will have strong analytical, written and verbal skills, and may hold CPC/CCS