Medical Reviewer III (Medicare Part A)

Empower AI is an AI-focused company supporting federal government healthcare and other missions. This role is a casual Medical Review Specialist III. You will perform Medicare Part A comprehensive medical record and claims reviews to make payment determinations for services including End Stage Renal Disease, Outpatient Rehabilitation Facilities, Rural Health Clinics, Critical Access Hospitals, and more.

Responsibilities include first and second level medical review, claims analysis using ICD-10-CM, CPT-4, and HCPCS coding, utilizing electronic health records, policy verification, and meeting quality and production standards. The role requires clinical judgment and ensuring compliance with quality and ISO standards.

Key qualifications:

• Registered Nurse (Bachelor’s, Associate’s, or Diploma in Nursing)
• Minimum 4 years related experience, including 3 years clinical RN experience
• Current RN licensure in one or more states or D.C.
• Ability to maintain confidentiality
• No adverse licensing actions or conflicts of interest

Preferred:

• Medicare Part A RN clinical review experience
• At least 2 years applying federal/local Medicare policies
• Medicare Contractor Medical Review Nurse or Commercial Insurance Home Health RN experience
• Spanish fluency a plus

Physical requirements include ability to sit for long periods. Empower AI is an equal opportunity employer committed to merit-based hiring.