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Heartland Ambulance Medical Review Nurse (MRN) in Muncie, Indiana

The Medical Review Nurse (MRN) will provide professional assessments and reporting of complex clinical data and support the medical review operations. The MRN position will perform comprehensive medical record and claim reviews from the Medicare fee-for-service program to ensure compliance within the guidelines of medical necessity as it pertains to Medicare coverage.

Responsibilities:

  • Perform medical record and claims review in accordance with all State, Federal and/or commercially mandated regulations

  • Maintain compliance with all regulation changes as they impact medical and utilization review practices

  • Analyze patient records and participate in interdisciplinary collaboration with billing staff and all recognized teaming partners and/or subcontractors

  • Document all review information into the appropriate Medical Review report and/or system. Communicate these report results to the appropriate supervisor

  • Utilize electronic health information imaging

  • Utilize Internet and Intranet resources for applicable research, e.g., evidence-based standards of care guidelines, quality measures, etc.

  • Utilize Mainframe shared system access to the Centers for Medicare & Medicaid Services? (CMS), Common Working File (CWF) to verify claims data information by query and search activities

  • Engage clients in appropriate communication that manages client expectations and builds a collaborative relationship with the client

  • Interact with skilled nursing home staff, clients, partners, and Heartland Ambulance Service, LLC staff in a professional and accountable manner, and as a representative of Heartland Ambulance Service, LLC.

  • Contribute to business development efforts for new sales and marketing to promote the business, including responses to requests for quotes, sources sought, proposals, and/or presentations as requested

  • Make clinical judgments based on evidence-based standards of care, review criteria and nursing practice guidelines when applicable

  • Understand and represent Heartland Ambulance Service, LLC mission, vision, and values to all internal and external customers

  • Perform other duties as requested

Requirements:

  • Bachelor's Degree in Nursing (BSN) or other related field preferred

  • Will give consideration to equivalent combination of education and a minimum of 3 years of directly related experience in lieu of a degree

  • Must be a Registered Nurse (RN) with an active license in state of Indiana

  • Experience in Medicare medical review or Medicare appeals review preferred. One or more years of DRG validation review experience is preferred

Preferred experience:

  • One year or more of experience applying federal and local policy for medical necessity and benefit coverage preferred

  • CCS or CPC Coding Certification required

  • Excellent writing and communication skills

  • Knowledgeable of quality measures and National Quality Strategy

  • Proficient user of Microsoft office suite such as Outlook, Access, Excel and Word

  • Certification in quality improvement/quality management, and/or utilization management/review preferred

Mandatory:

  • Must have no adverse actions pending or taken against them by any State or Federal licensing board or program

  • Must have a clean background check

  • Must have the ability to pass a Drug examination

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