North Carolina Licensed Medical Review Analyst
Company: VirtualVocations
Location: Vista
Posted on: May 20, 2025
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Job Description:
A company is looking for a Medical Review Analyst to evaluate
medical necessity and reimbursement for complex claims.
Key Responsibilities
Determine medical necessity, benefit eligibility, and reimbursement
allowances for complex claims using clinical expertise and various
resources
Ensure compliance with regulatory and accrediting body requirements
during reviews and determinations
Document and report inappropriate billing patterns and conduct post
adjudication reviews of claims
Required Qualifications
RN, PA, or NP with a minimum of 3 years of clinical experience,
preferably in diverse clinical settings
LPN with a minimum of 5 years of clinical nursing experience in
varied clinical environments
Must hold and maintain a valid North Carolina clinical license
Keywords: VirtualVocations, Pico Rivera , North Carolina Licensed Medical Review Analyst, Professions , Vista, California
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