Registered Nurse Medical Reviewer

Job Summary

To support seasonal healthcare operations, the remote Medical Reviewer, Registered Nurse 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
• Participate in dispute resolution and provide documentation to support claims re-examination
• 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 in a productivity-based claims or case working environment
• 3+ years of remote work experience with technology systems, ideally 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