Medical Reviewer II
Health Care Service Corporation · Richardson, TX · 2 wk ago
Administrative$62k–$136k/yrFull-time
About the role
This position is responsible for performing accurate and timely medical review of regular business, state of Texas and national accounts claims suspended for medical necessity, contract interpretation, and pricing; and to initiate and/or respond to correspondence from providers or members concerning medical determinations.
Responsibilities
- Perform accurate and timely medical review of claims
- Suspend claims for medical necessity
- Interpret contracts and determine pricing
- Initiate and respond to correspondence from providers or members regarding medical determinations
Requirements
- Registered Nurse with current, active, unrestricted RN license in the state of operations (or reciprocity)
- For compact licensee changing permanent residence to state of operations, must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire
- 3 years clinical experience
- Verbal and written communications skills
- Analytical and decision-making skills
- Customer Service
Qualifications
- Preferred: Prior MRU experience
- Preferred: NICU experience
Skills
- None specified
Benefits
- Compensation range: $61,500.00 - $136,100.00
- Exact compensation may vary based on skills, experience, and location
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