#CHARGE NURSE SALARY TEXAS MANUAL#

Return documented decision electronically to Companies via established protocols and timeliness parameters (i.e., 20 days from receipt of the medical record for pre-payment reviews and 50 days from receipt of the medical record for payment reviews).

This rationale must be in sentence format so that it may be inserted directly into the response to the provider, must be clear and well-written, and contain sufficient information to educate the providers on how the review decision was made

Complete the documentation of the reason for payment, reduction, or denial of service for all claims on an electronic decision template to be provided by Companies.

Companies will review the three-claim sample for accuracy of claim decision and will make and return decisions to the MRS within 24 hours or less.Provide a claim sample of three (3) claims to Companies via established protocols and timeliness parameters (i.e., 18 days from receipt of the medical record for pre-payment reviews and 48 days from receipt of the medical record for post payment reviews) for quality review prior to finalization of documentation of reason for payment, reduction, or denial of service to ensure accuracy of claim decision making.Ensure that all documentation includes a valid signature consistent with the signature requirementsĭocumentation of rationale for processing decisions.Review documentation for medical necessity per guidelines outlined in the Social Security Act 1862(a)(1).

#CHARGE NURSE SALARY TEXAS MANUAL#

Utilize the applicable Medicare policies (i.e., Local Coverage Determinations, National Coverage Determinations, Internet-Only Manual (IOM) citations, inpatient tools, etc.) to ensure the services comply with all Medicare regulations and documentation requirements.

Review medical record documentation within CMS timeliness parameters (i.e., 20 days from receipt of the medical record for pre-payment reviews and 50 days from receipt of the medical record for post payment reviews).

Complete a projected number of clinical review hours while meeting timeliness and accuracy standards and completing documentation of clinical decisions for remittance.

Perform clinical reviews of Medicare Part A and Part B claims for Medical Review, Redeterminations/Appeals (Appeals), and Prior Authorization requests (collectively, the “Services”) in accordance with CMS (Centers for Medicare & Medicaid Services) requirements.

Take advantage of our competitive, comprehensive benefits package including medical, dental, vision, life, short-term disability, long-term disability & 401(k).

Maintain work-life balance with guaranteed 8-hour shifts.Maximize family time with no weekend, Holiday, or on-call requirements.We recognize the foundation of our firm is our people and we continue to rise above our competition by hiring the best.Īvosys is seeking a Remote Registered Nurse - Medical Review Specialist to work remotely to review Medicare clains. Founded in 1998, Avosys provides services nationwide to Federal, Commercial, Local and State clients. Overview:Avosys is a growing integrator of professional, technological and management solutions services.

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