Medical Reviewer III – Medicare DME Claims
Posted 2026-05-06
Remote, USA
Full-time
Immediate Start
- Job Description:
- Perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment (DME).
- Perform projects or duties as assigned as a Medical Review Specialist.
- Conduct in-depth claims analysis utilizing ICD-10-CM, AMA-CPT, and HCPCS Level II coding principles.
- Utilize electronic health information imaging and input medical review decisions by electronic database module.
- Ensure departmental compliance with quality management system and ISO requirements.
- Requirements:
- Must be a Registered Nurse obtained by either a Bachelor's degree – OR - Associate's degree – OR - Diploma in Nursing.
- At least four (4) years claims knowledge either from billing, reviewing, or processing of Durable Medical Equipment.
- At least three (3) years clinical experience as a Registered Nurse.
- Minimum four (4) years federal and local policy applications in relation to Medicare insurance procedures for medical necessity for Physician Office practices, Laboratory, and Ambulance Services.
- Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
- Ability to keep sensitive and confidential material private.
- Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI).
- Benefits:
- Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs.
- Comprehensive medical record and claims review for Medicare Durable Medical Equipment (DME).
- Serve as a critical component in meeting our mission of providing excellent services to our clients.
- Opportunity to be at the forefront of activities related to implementing healthcare reform on a national level.