Registered Nurse Payment Integrity

Job Summary

Working remotely within Oregon, Washington, Idaho, Utah, or North Dakota, the full-time Payment Integrity Nurse I will conduct post-service reviews of claims to ensure compliance with clinical review standards, reimbursement accuracy, and coding guidelines.

Key responsibilities:

• Applies nursing expertise to ensure compliance with medical and reimbursement policies
• Performs reviews of claims and corresponding medical records to ensure appropriate payment
• Collaborates with physician advisors and other departments to resolve claims adjudication issues

Required qualifications:

• Associates or Bachelor's Degree in Healthcare
• Minimum 3 years of experience in a clinical setting, health insurance, or claims review
• Unrestricted licensure or certification in OR, WA, ID, or UT in a relevant health discipline
• Minimum 3 years of direct clinical care experience
• Preferred: Certified Professional Coder (CPC) certification