Utilization Review Analyst (Registered Nurse)

COMPANY PROFILE:  EDS is a leading global technology services company delivering business solutions to its clients. EDS founded the information technology outsourcing industry more than 40 years ago. Today, EDS delivers a broad portfolio of information technology and business process outsourcing services to clients in the manufacturing, financial services, healthcare, communications, energy, transportation, and consumer and retail industries and to governments around the world. With more than $20.5 billion in annual revenue, EDS is ranked 108th on the Fortune 500. The company?s stock is traded on the New York (NYSE: EDS) and London stock exchanges. Learn more at: www.eds.com.

 

JOB TITLE:  Utilization Review Analyst (Registered Nurse)  

 

The Utilization Review Analyst (nurse) will be accountable for the review and evaluation of medical records to determine if Medicare claims were filed and/or paid appropriately in an effort to support medical review objective and for proper adjudication of medical payments. 

 

JOB REQUIREMENTS: 

 

? Bachelor?s degree in nursing

? Registered in the State of CA

? Strong knowledge of Medicare claims processing guidelines.

? Excellent communication and organization skills

? Excellent analytical skills with the ability to research and resolved problems

? Experience in reviewing and performing Medical Review claims

? General knowledge of laws and regulations

? Ability to work with minimal direction

? Strong PC knowledge and skills

? Full understanding of ICD-9 and CPT coding

 

ESSENTIAL FUNCIONS: 

 

? Ability to administer Medicare program guidelines based on the interpretation of Medicare regulations.

? Ability to interact with employees and providers, regarding verification and explanation of Medicare benefits and decisions.

? Ability to respond to questions internally and externally.

? Ability to make education presentations, assists training other employees.

? Ability to administer Medicare Program guidelines based upon interpretation of Medicare regulations and use of corrective actions.

 

 

Location:  Los Angeles, CA  90017

 

This position is not one for which the employer will sponsor an individual for employment visa status or pay relocation assistance. 

 

Please apply on-line at www.edscareers.com, position 2267379 - Utilization Review Analyst.

 

EDS IS A REGISTERED MARK AND THE EDS LOGO IS A TRADEMARK OF ELECTRONIC DATA SYSTEMS CORPORATION. EDS IS AN EQUAL OPPORTUNITY EMPLOYER AND VALUES THE DIVERSITY OF ITS PEOPLE. COPYRIGHT 2006 ELECTRONIC DATA SYSTEMS CORPORATION. ALL RIGHTS RESERVED.