Medical Review Nurse/Contract Specialist

Your Standard is Excellence

You've been looking for an opportunity to work with people who share your commitment to a higher standard. You imagine building a career and even enjoying your work.

Good News.

We've been looking for you, too!

Coventry Health Care is a leader in the managed care industry. State-of-the-art technology and great people enable us to provide service that differentiates us from the competition. Coventry offers a highly rewarding professional environment built around meaningful projects, best-of-breed technologies and excellent training and development opportunities. And, Coventry has been named to Barron's 500 – Fortune 500 – and Forbes Platinum 400.

At Coventry Health Care, you'll have the opportunity to collaborate with talented and dedicated professionals, while developing and expanding your career. Consider building a career with us!

 

We have the following opportunity at our Scottsdale, AZ location:

 

Medical Review Nurse/Contract Specialist

Requisition # 83574

As part of our national PPO Network Division, this position is relied on to perform charge audits and medical claims review of high dollar hospital ($75,000 in charges or more) and medical claims ($50,000 and above) for coding and billing accuracy based on the itemized billing statements. This position will then negotiate healthcare provider claim settlements for both PPO and non-network providers, based on audit findings, provider history, market rates, claim components, plan provisions and member benefit levels.

 

Requirements:

· RN with current state RN license, or LPN with current state license.

· Prefer an Associate’s or Bachelor’s degree and/or Certified Medical Audit Specialist or Certified Professional Code-CPC-H.

· Significant (usually 3+ years) high dollar charge review experience.

· Expert knowledge of medical terminology.

· ICD-9, CPT-4 and HCPCS coding experience.

· Prefer a working knowledge of coordination of benefits and healthcare products under both fully insured and self-funded arrangements.

· Ability to maintain production levels and quality goals.

· Strong analytical and problem-solving skills.

· Excellent organization, interpersonal and communication skills.

· Ability to use standard office software.

 

To join our dynamic organization, which offers an excellent salary and benefits package, please submit your resume with salary history at: www.cvty.com, then enter the ”careers,” section and apply online to requisition number 83574 in Scottsdale, AZ. M/F/D/V EOE.