MEDICAL SERVICES REVIEWING NURSE II

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DHMH, The Office of Inspector General, Baltimore, MD

The primary purpose of the Medical Services Reviewing Nurse II is to assist the Maryland Department of Health and Mental Hygiene(DHMH), Office of the Inspector General (OIG) in detecting and deterring Fraud, waste, and abuse within the Medical Assistance Program. As a employee of the OIG's Program Integrity Clinical unit, Reviewing Nurse will assist in conducting audits and investigations of health care providers, and suppliers of durable medical equipment/supplies who are suspected of overbilling or detecting fraud with Maryland Medicaid program. This position will collaborate with analysts in the OIG's Data Unit to conduct data mining for identifying billing anomalies and monitoring services. This position will utilize the nursing process with knowledge and experience in Current Procedural Terminology(CPT, Internal Classification of Diseases, Clinical Modifications (ICD-10-CM), Health Care Common Procedure Coding (HCPCS), and general patient billing. The incumbent should have knowledge of State and Federal regulations, Medical terminology, root cause analysis, and experience in regulatory compliance is essential.

Education: Possession of a Bachelor’s degree in Nursing or a related field from an accredited college or university.

Experience: One year of experience reviewing medical services claims to ensure that the nature and quality of services are in accordance with State and federal regulations.

Note: 

1. Two years of experience as a Registered Nurse may be substituted for the required education.

2. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Nursing classifications or Nursing  specialty codes in the Nursing field of work on a year-for-year basis for the required education.

The successful candidate should be able to review Medical Claim, Medical Records, and assist in conducting both onsite and desk reviews.

The applicant must have at least six months of experience in Current procedural Terminology(CPT) and International Classification of Disease (ICD-9 or ICD- 10).

1. Candidates for positions in this classification must possess a current license as a Registered Nurse from the Maryland State Board of Nursing, 4140 Patterson Avenue, Baltimore, Maryland 21215.  **A copy of your nursing license should accompany your application.**

2. Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator’s license valid in the State of Maryland.

Applicants who meet the minimum qualifications will be evaluated.  The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position.  Therefore, it is essential that you provide complete and accurate information on your application.  Please report all related education, experience, dates and hours of work.  For education obtained outside the U.S., a copy of the equivalent American education as determined by a foreign credential evaluation service must accompany the application.  All information concerning your qualifications must be submitted by the closing date.  We will not consider information submitted after this date.  Applicants certified to list will receive eligibility for a period of one (1) year.  Eligibility may be extended beyond one (1) year period.

Online applications are highly recommended, however the paper application may be submitted to DHMH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201.  The paper application must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

Incorrect application forms will not be accepted.

If you need to submit additional information, the preferred method is to upload.  If unable to upload, please fax requested information only to 410-333-5689.

Should additional information regarding this recruitment be required, please contact the DHMH Recruitment and Selection Division at 410-767-1251 or via email at dhmh.jobs@maryland.gov. 

Appropriate accommodations for individuals with disabilities are available upon request by calling: (410) 767-1251 or MD TTY Relay Service 1-800-735-2258.

The incumbent in this position is a member of a covered bargaining unit and will be required to pay a bi-weekly service fee to the exclusive representative of the bargaining unit.

STATE OF MARYLAND BENEFITS

As an equal opportunity employer, Maryland is committed to recruiting, retaining and promoting employees who are reflective of the State’s diversity.

The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

We thank our Veterans for their service to our country, and encourage them to apply.

Bilingual applicants are encouraged to apply.