Clinical Investigator Job in Buffalo 14221, New York Us

Monster

Subsidiary of Independent Health

About the Job

Job Description


Qualifications

  1. Licensed registered nurse with minimum 5-7 years medical claims investigation related experience.  Bachelor of Science in Nursing preferred.
  2. Minimum of six (6) years experience with medical insurance claims and medical record reviews/audits using standard coding (HCPC, CPT, ICD-9, and DRG), preferably in the managed care setting.
  3. Familiarity with insurance investigative processes, provider licensure and quality of care issues preferred.
  4. Works independently with a wide latitude of freedom to determine the direction of cases.
  5. Ability to assume responsibility, maintain data and reports in consideration of and maximization of confidentiality.
  6. PC/Windows experience and knowledge of claims audit software preferred.
  7. Demonstrated ability to prepare medical record audit reports.
  8. Strong organizational skills, verbal and written communication skills.
  9. Demonstrated ability to communicate with providers, and efficiently and accurately gather information from provider offices.
  10. Understands the importance of maintaining the physical and technical security and privacy of protected health information (PHI).