Remote Registered Nurse Clinical Reviewer II

Location: Nationwide
Compensation: To Be Discussed
Staff Reviewed: Tue, Nov 22, 2022
This job expires in: 20 days

Job Summary

A non-profit health insurance company has an open position for a Remote Registered Nurse Clinical Reviewer II.

Candidates will be responsible for the following:

  • Assisting the audit and investigative teams in the development of clinical and coding-based audit tools
  • Conducting claim reviews against medical records to determine claim accuracy for claims payment
  • Drafting proposed provider education and formal corrective action plans for clinical and coding deficiencies

Qualifications for this position include:

  • Significant experience auditing medical records against claims is required
  • Minimum of five (5) years clinical practice experience required
  • Bachelor of Science in Nursing Degree or equivalent experience years of relevant experience is required
  • CPT, HCPCS and ICD-10 coding knowledge is required
  • Proficient with Microsoft Office Word, Excel and PowerPoint
  • Broad-based clinical and medical coding knowledge

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