Registered Nurse Medical Reviewer

Job Summary

To support the review of Medicare Fee-for-Service claims, the full-time Remote Registered Nurse Medical Reviewer will perform automated and complex reviews, assess payment accuracy, and ensure compliance with Medicare policies and guidelines.

Key responsibilities

• Conduct automated and complex reviews of Medicare claims to evaluate overpayments, underpayments, and proper payments
• Participate in dispute resolution by re-examining claims and providing supporting documentation
• Collaborate with key personnel to ensure consistency, accuracy, and process 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 working environment
• 3+ years of remote work experience with various technology systems
• Active Medical Coding Certification (CPC, CCS, or equivalent) required
• Active license as a Registered Nurse in good standing in the United States