Registered Nurse Medical Reviewer

Job Summary

To assess Medicare Fee-for-Service claims and ensure compliance with policies, the full-time Registered Nurse Medical Reviewer will perform automated and complex reviews, participate in dispute resolution, and maintain documentation while working remotely.

Key responsibilities

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

Required qualifications

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