Medical Reviewer III (Medicare DRG)

Empower AI is AI for government. Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. Our proven Empower AI Platform® provides a practical, sustainable path for clients to achieve transformation that is true to who they are, what they do, how they work, with the resources they have. The result is a government workforce that is exponentially more creative and productive. For more information, visit www.Empower.ai. Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs. This designation reflects the company’s commitment to hiring and supporting active-duty and veteran employees.

Empower AI: As a Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis Related Group (DRG) claims. Perform projects or duties as assigned as a Medical Review Specialist. You will serve as a critical component in meeting our mission of providing excellent services to our clients. Your experience ensures an exciting and rewarding opportunity to be at the forefront of activities related to implementing healthcare reform on a national level. In assuming this position, you will be a critical contributor to meeting Empower AI’s mission: To deliver innovative, cost-effective solutions and services that enable our customers to rapidly adapt to dynamic environments.

Perform comprehensive medical record and claims review to make payment determinations based on Insurance coverage, coding, and utilization of services and practice guidelines for Medicare DRG. Performs first level of Medical Review in determination of claims payment review. Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles. Utilize electronic health information imaging and input medical review decisions by electronic database module. Utilize internet and intranet sources for policy verification. Utilize Microsoft Office suite and other software templates as associated source input for claims review. Make clinical judgment decisions based on clinical experience when applicable. Responsible for review of Medicare DRG claims. Meeting quality and production standards. Ensuring departmental compliance with quality managements system and ISO requirements. Completes other projects or duties assigned by the Medical Review Lead Specialist.