Registered Nurse Medical Reviewer

Job Summary

Working remotely in a full-time capacity, the Registered Nurse Medical Reviewer will perform automated and complex reviews of Medicare Fee-for-Service claims, ensuring compliance with Medicare policies and guidelines while documenting findings accurately.

Key responsibilities

• Conduct automated and complex reviews of Medicare claims to assess payment accuracy and compliance with policies
• Participate in dispute resolution by re-examining claims and providing necessary documentation
• Collaborate with key personnel to ensure consistency and continuous improvement in review processes

Required qualifications

• 5+ years of direct medical coding or billing experience in a healthcare environment
• 3+ years of experience in a productivity-based claims or case management environment
• 3+ years of remote work experience with various technology systems, preferably with Medicare Fee For Service experience
• Active Medical Coding Certification (CPC, CCS, or equivalent) required
• Active Registered Nurse license in good standing in the United States