What are the responsibilities and job description for the Records Review/Prepayment Nurse position at TMF Health Quality Institute?
TMF Health Quality Institute
www.tmf.org
Please visit our Career Center to Apply and View the Full Job Description
https://jobs.tmf.org/
**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**
*This position is located Remote- Texas*
Position Purpose
Conducts contract activities in accordance with state agencies and the state policies and requirements.
Essential Responsibilities
Obtains and reviews medical records to determine compliance with review and program policies.
Documents review findings and recommends adjustments or denials of services for each claim detail.
Obtains physician/dentist decisions on medical necessity-related findings.
Composes narrative summary of record review findings and writes education or recoupment letters as directed.
Works with State customer on review findings.
Performs actions for case disposition which may include, but is not limited to, assisting in conducting provider
Minimum Qualifications
Education
Diploma Nurse or
Associates degree in
nursing
or related discipline
from an accredited college or university
License and Certification
Three (3) years healthcare
Two (2)
years clinical in
a
healthcare setting
One (1) year utilization management, retrospective review, medical record review, or claims review
www.tmf.org
Please visit our Career Center to Apply and View the Full Job Description
https://jobs.tmf.org/
**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**
*This position is located Remote- Texas*
Position Purpose
Conducts contract activities in accordance with state agencies and the state policies and requirements.
Essential Responsibilities
Obtains and reviews medical records to determine compliance with review and program policies.
Documents review findings and recommends adjustments or denials of services for each claim detail.
Obtains physician/dentist decisions on medical necessity-related findings.
Composes narrative summary of record review findings and writes education or recoupment letters as directed.
Works with State customer on review findings.
Performs actions for case disposition which may include, but is not limited to, assisting in conducting provider
Minimum Qualifications
Education
Diploma Nurse or
Associates degree in
nursing
or related discipline
from an accredited college or university
License and Certification
- Registered Nurse (RN) with an active Texas license
- Coding Certification, preferred
Three (3) years healthcare
Two (2)
years clinical in
a
healthcare setting
One (1) year utilization management, retrospective review, medical record review, or claims review
- Ben
