RN Medical Reviewer - Medicare

Job Summary

To support the review of Medicare claims for Inpatient Rehabilitation Facility (IRF) services, the remote RN Medical Reviewer - Medicare will conduct complex medical reviews, perform pre-claim review determinations, and evaluate Additional Documentation Request responses while adhering to strict turnaround requirements.

Key responsibilities

• Conduct pre-claim review determinations for Medicare claims related to IRF services
• Evaluate Additional Documentation Request responses and communicate findings to providers
• Ensure compliance with production-driven work and contractual turnaround requirements

Required qualifications

• Associate Degree in Nursing or graduation from an accredited School of Nursing
• Active RN licensure in the state hired or an active compact multistate RN license
• Minimum of 2 years of clinical experience
• Proficiency in Microsoft Office software
• Ability to work independently and make sound decisions