Medical Record Review Registered Nurse

Job Title: Medical Record Review Registered Nurse Dutation: Contract (12+ Months) Work Arrangement: Hybrid Shift: 7:30 AM - 4:00 PM Description: Be available as a full-time consultant, approximately 37.5 hours per week; Possess an active Pennsylvania Registered Nurse license; Possess a documented work history of five (5) or more years of experience with claims review/coding or processing; be familiar with HCPCS II, CPT, or Dental coding; Possess computer skills, including familiarity with Microsoft Office programs, including Microsoft Excel/Word/PowerPoint; Possess prior experience with PROMISe or similar claims processing system; Possess prior experience with Medicare or Medical Assistance coding rules; Possess prior experience with researching medical policies, out of state comparison, participation in studies or projects. Responsibilities: Provide oversight to projects and processes for support of managerial leadership. Consultant will be assigned to workgroups and project teams. Assignments will consist of a combination of ongoing process responsibilities, standing workgroup participation, and time-limited projects related to the management and operations of all aspects of the Pennsylvania Medicaid program, including but not limited to: Evaluation and implementation of system enhancements for provider enrollment, provider inquiry, and medical review; Evaluation of current processes and implementation of recommended process improvement; Consult with senior staff to outline major operational issues and develop resolutions based on sound data analysis; Act as a liaison between the Client and external stakeholders (individuals and/or groups); Assist in determining if any changes should be made to criteria or regulations to better serve clients; Review certain claims, analyze, and process through the payment system; Provide operational input for claims processing decisions; Assist with coding and procedure code groupings; Participate in the yearly coding updates and assist in updating the system according to the reviewed and accepted codes for the PA Medical Assistance Program; Perform other related duties as assigned by the managerial staff; Consultant will report to the state supervisor staff. Assignments will be received verbally or in writing, and will be carried out independently with minimal direct supervision; Consultant, when requested, will work at one or more of the Department's work sites. Consultant's primary work location will be in Harrisburg, PA. Consultant will be provided with a desk, computer, phone, and all items necessary for them to complete assignments.