CommUnityCare

CommunityCare in Tulsa, Oklahoma is seeking a Medical Review Examiner Nurse to audit provider and facility claims and ensure compliance with billing practices. The role involves reviewing claims, collaborating with the Medical Director, and maintaining quality control databases. The ideal candidate will have an active RN or LPN license in Oklahoma, a strong understanding of medical coding, and at least five years of experience in clinical operations. Strong communication skills are essential for this position. #J-18808-Ljbffr

OverviewThis position is responsible for conducting coding audits, communicating results and recommendations to providers, management, and executive administration, and providing training and education to providers and ancillary staff.This position will support the implementation of changes to the CPT, CDT, HCPCS and ICD-10 codes on an annual basis.ResponsibilitiesEssential Duties :Conduct prospective and retrospective chart reviews (i.e.baseline, routine periodic, monitoring, and focused) comparing medical and / or dental record notes to reported CDT, CPT, HCPCS, and ICD codes with consideration of applicable FQHC and payer / title / grant coding requirements.Identify coding discrepancies and formulate suggestions for improvement.Communicate audit results / findings to providers and / or ancillary staff and share improvement ideas.Work with the Office of the CMO and provider leadership to identify and assist providers with coding.Report findings and recommendations to Compliance...