What are the responsibilities and job description for the Medical Records RN - Claim Review position at ARK Solutions, Inc.?
Position : Medical Records RN – Claim Review
Long term Contract through 2027
Washington, DC (Hybrid)
Education : Must be a Licensed Medical Professional, with an active license..
Job Description :
Serves as a client Subject Matter Expert ( "SME”) on medical-related questions raised by the Claim Review and Appeals teams (client and contractor attorneys) and the Special Master.
Reviews medical records, documents findings using applicable forms, and recommends conditions for verification by the Health Program following specific Health Program guidelines and instructions.
May support the appeals process either through review of medical information submitted as part of the pre-appeal materials, through participation in hearings, or by providing expertise to the team as they draft the post-appeal recommendation for the Special Master's review.
Reviews medical records for identified claims to assess the severity of the claimant's physical health conditions, as evidenced in the records. Supports claim review in evaluating severity for non-economic loss awards; evaluating disabling conditions and the percentage attributable to the eligible condition; determining if conditions with different names are the same condition; and providing expertise to the team pertinent to clinical experience.
Required Skills :
Must be a Licensed Medical Professional, with an active license.
Five years recent Nursing / Case Management / Utilization Review or Legal Nurse Consulting experience
Background in pulmonary and / or oncology specialties preferred.
