Lead Claims Review Analyst

 

**PLEASE APPLY TO THIS POSITION AT WWW.FCSO.COM**

**THIS POSITION WILL BE LOCATED IN THE WESTERN UNITED STATES**

First Coast Service Options, Inc. (FCSO), is a wholly owned subsidiary of the largest health insurance company in the state of Florida. Our exciting new business venture will provide audit, oversight, anti-fraud, and waste and abuse monitoring of Medicare Parts A, B, and C, the Medicare Prescription Drug Benefit (Part D), Durable Medical Equipment, Home Health and other aspects of the Medicare and Medicaid program for several western states. As a part of Florida's most successful health insurance company, we are an equal employment opportunity employer and are committed to excellence in all that we do.

JOB DUTIES:

Job duties include, but are not limited to:

*Medically review cases of potential law enforcement referrals and other administrative actions
*Review claims to determine if services were documented, covered, and medically reasonable and necessary
*Highlight potential fraudulent activities through medical review of the claims data filed to Medicare for payment

JOB REQUIREMENTS:

*Registered Nurse or LPN with active license
*Minimum two years of utilization/quality assurance review and ICD-9-CM/CPT-4 coding experience
*Experience in coding and abstracting, working knowledge of Diagnosis Related Groups, Prospective Payment Systems, and Medicare coverage guidelines
*Advanced knowledge of medical terminology and experience in the analysis and processing of Medicare claims, utilization review/quality assurance procedures

**If you are an experienced fraud and abuse analyst, investigator, auditor, or have a background in Medicare or Medicaid administration and have an interest in exploring other career opportunities with our exciting company, we invite you to send your resume to careers@fcso.com.**