Sr. Medical Review Nurse

Williams Consulting LLC is seeking candidates for Medical Review Nurse positions to join our growing team. This is a 100% remote position in support of the Centers for Medicare and Medicaid Services. Williams Consulting LLC is an 8a, HUBZone and Woman-owned Small Business with Federal, State, Local and Commercial clients. We take great pride in our ability to provide exceptional customer service and we value our employees and recognize their contributions to the success of our clients and our company. We offer competitive salaries and support flexible work locations and scheduling, when possible. We offer competitive benefits including Medical, Vision, and Dental coverages through national plans. Life, AD&D, Short & Long Term Disability Insurance, PTO, and 401k.

As a member of our Federal Team the Medical Review Nurse (MRN) will support to the Medical Claim/ Medical Review operations. This position applies clinical knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local policies, are under accepted billing and coding practices, and meet standards of medical care. Responsibilities include but are not limited to making determinations based on established policies and procedures, reviewing Medicare Beneficiary medical records, evaluating medical coding practices and making determinations. The Medical Review Nurse role may also involve Case/Project discussions with impacted stakeholders.

Reviews Complex Medical Record and Billing/Claims Cases/Projects Evaluates Coding Practices Applies Clinical guidelines and other coverage/Medical criteria in reviewing cases/projects Interacts with various stakeholders as required to support case review Completes inquiry letters, investigation finding letters, and case summaries Investigates and refers all potential fraud leads to the appropriate identified resources Responsible for case specific and other required data entry, tracking and reporting Performs other related Program duties as assigned