Registered Nurse Clinical Claim Review

Job Summary

Working remotely, the full-time Registered Nurse Clinical Claim Review will perform claim reviews to verify correct coding and charges, document findings, and ensure compliance with state and federal guidelines.

Key responsibilities:

• Conduct clinical reviews of claims against medical records to determine support for claims
• Maintain productivity and accuracy standards while analyzing billing and departmental guidelines
• Document findings and assist in the resolution of claims to support negotiations and appeals processes

Required qualifications:

• Associates degree
• Active and unrestricted RN license in the state of residence
• 2+ years of clinical experience within an acute care setting
• 1+ years of experience in Utilization Management, claim review, or medical record review
• Intermediate level of computer skills, including proficiency in Microsoft Office