Registered Nurse Clinical Reviewer

Job Summary

To support the coding department, the full-time Registered Nurse Clinical Reviewer will perform clinical validation by ensuring diagnosis codes billed by providers are supported within medical records, while working remotely from anywhere in the United States.

Key responsibilities

• Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record
• Interpret clinical guidelines and apply them to clinical reviews while maintaining high-quality case management
• Write clear and concise rationales in support of findings and demonstrate the ability to work in a high-volume production environment

Required qualifications

• Minimum of two years' experience in clinical validation in a payment integrity setting required
• Unrestricted Registered Nurse with active RN licensure required
• CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification preferred
• Knowledge of ICD-10 coding and basic knowledge of DRG validation and coding
• Ability to use Windows PC with the capability to utilize multiple applications simultaneously