MCS Puerto Rico is seeking a clinical reviewer to conduct post-service and pre-payment claim reviews to determine medical necessity, coding accuracy, and reimbursement compliance, leveraging CMS guidelines and policy knowledge.
The role requires a Bachelor's degree in Nursing, at least two years of clinical nursing experience, and an active Puerto Rico RN license; Spanish and English communication skills are required to collaborate with providers and internal teams.
#J-18808-LjbffrClinical Claims Integrity Specialist in san juan at Unknown Company
This position is listed as full time and onsite.