LEAD CLAIMS REVIEW ANALYST

Registered Nurse

TriCenturion, Inc., Columbia, South Carolina

TriCenturion, Inc., a leader in defending the public and the private interests against fraud and abuse for Medicare and Medicaid Services (CMS), is seeking Lead Claim Review Analysts (LCRAs) for our Columbia, South Carolina office.  This position will initially focus on review of claims related to DMEPOS, but may also involve other Medicare and Medicaid claim types.

The LCRA:

• Performs medical pre-pay and/or post-pay claims review in support of Benefit Integrity investigations and functions. 
• Makes medical determinations and coverage decisions and makes payment recommendation in accordance with stated/published practices, policies or procedures.
• Offers medical knowledge and professional expertise to other team members in their capacity as Registered Nurses.
• Performs joint on-site investigations with Investigators.

Qualified candidates must have a degree from an accredited school of nursing, have an active South Carolina RN license with 2 years of clinical or other relevant experience, communicate effectively (both orally and in writing), and be competent with standard desktop software such as Microsoft Word.  A BSN degree and utilization/quality assurance review experience are preferred.

TriCenturion, Inc. offers a comprehensive benefits package to include competitive salaries; health, dental, and vision coverage; 401K; Flexible Spending Accounts; company paid life and disability; 10 paid holidays per year; Paid Time Off; and Education Assistance.   

TriCenturion is an Equal Opportunity Employer.