Review & Evaluation RN-Hybrid (103249)
Company: A-Line Staffing Solutions
Location: Harrisburg
Posted on: June 27, 2025
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Job Description:
Job Title: Review & Evaluation RN (Hybrid) Location: Harrisburg,
PA * Will be required to come into the office once a week and every
day until training is complete. Shift: Mon-Fri 8am-4pm Pay:
$31.00/hr. Benefits: Health, Dental, Vision, Life Insurance, and
short-term disability after 90 days For more information, please
contact Breanna D. directly at bdrollinger@alinestaffing.com
R&E Nurse Description/Duties · Identify discrepancies through
the analysis of paid claims, itemized bills, and computer reports
through the Fraud Abuse Detection System(FADS). This includes but
is not limited to analysis of paid claims for patterns identified
with high-cost, high-volume providers, and potential cases for
review. · Select, review, analyze and evaluate cases
retrospectively to monitor compliance with State and Federal
Regulations. Services are monitored for medical necessity and
quality of care. Verifying that services ordered were rendered, and
all rendered services were ordered and are appropriate. Analyze for
up coding, duplicated billing and unbundling of services billed.
Use the ICD-9CM diagnosis and procedure manuals, coding clinics,
CPT and HCPCS manuals, and other related manuals to determine that
the paid claim was billed appropriately. · Prepare case findings,
prepare preliminary and final letters to providers, research and
utilize appropriate MA regulations, MA bulletins and federal
regulations. Keep the section supervisor informed of case
development and progress as well as keep the Bureau’s Case Tracking
system and the Sections tracking system updated for each active
case. · Coordinate and participate in teleconferences, when
requested by the provider, scheduling times/dates with supervisor,
Division Director, physician consultants and/or other parties
involved with the case. · Prepare claims to recover money for
violations identified during the review process.
Keywords: A-Line Staffing Solutions, Philadelphia , Review & Evaluation RN-Hybrid (103249), Healthcare , Harrisburg, Pennsylvania
