Medical Claims Reviewer - Remote

{"Conduct medical claim reviews for complex services, pre-authorizations, appeals, fraud investigations, and coding accuracy.","Use established clinical guidelines and protocol sets to make coverage and reimbursement determinations.","Ensure claims meet contractor standards and comply with Medicare guidelines.","Document medical rationale for claim approvals or denials.","Provide education and support to internal/external teams regarding medical reviews, coverage determinations, and coding procedures.","Participate in quality control activities and support LPN team members.","Assist with special projects and additional responsibilities as assigned."}