Registered Nurse Medical Reviewer

Job Summary

To support the review of Medicare claims, the full-time Remote Medical Reviewer, RN Coder will perform automated and complex reviews of claims, ensuring compliance with Medicare policies while documenting findings and collaborating on process improvements.

Key responsibilities

• Conduct automated and complex reviews of Medicare Fee-for-Service claims to assess payment accuracy
• Participate in dispute resolution by re-examining claims and providing necessary documentation
• Collaborate with team members to ensure compliance 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 system
• 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 license as a Registered Nurse in good standing in the United States