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Registered Nurse Analyst

Date: Oct 21, 2021

Location: Baton Rouge, LA, US, 70809-0204

Company: Gainwell Technologies LLC

Reviews claims using medical records and system reports to determine proper documentation, utilization and appropriateness of medical services and to identify possible fraud, waste or abuse.

 

Overview:

The Registered Nurse Analyst will work in the SURS department managing post payment review of Medicaid claims to identify fraud, waste, or abuse. 

 

Essential Job Functions

Performs post payment analysis of medical claims and records. Uses independent judgment to determine sanction level, and forwards recommendation to management for approval. Prepares reports and correspondence. Research policy/standards. Meets established production requirements consistently. Closes assigned cases, Demonstrates consistent movement of cases towards closure, good quality work in conjunction with efficient and effective case movement. Demonstrates knowledge and understanding of SURS procedure and process. Contributes positive attitude to meet goals. Utilizes data mining tool system with minimum assistance.

 

Basic Qualifications

  • Associates or Bachelor's degree in nursing
  • Four or more years of experience as a registered nurse
  • Experience working with medical procedures and techniques
  • Coding and utilization review experience (Highly desirable)

 

Other Qualifications

  • Good communication skills
  • Good organization and time management skills
  • Ability to work in a team environment
  • Ability to keep sensitive and confidential material private

 

Work Environment

  • Office environment
  • 40 hour week in office with some opportunity for Work from home once established.