North Carolina Licensed Nurse Claims Analyst

Job Summary

A company is looking for a Nurse Claims Analyst to provide clinical expertise in the Mass Tort lien resolution process.

Key Responsibilities

• Conduct high-volume QA reviews of claimant-level medical records to determine relatedness to underlying litigation
• Create and establish medical claim audit protocols for consistent and defensible determinations
• Document review findings and identify trends to improve processes and protocols

Required Qualifications

• 3+ years of experience in medical record review, claims auditing, or medical billing and coding
• 1+ years of experience in itemized bill review or equivalent claims review experience
• Active, unrestricted RN license in good standing within the United States
• Strong understanding of payer policies and medical coding systems such as CPT, ICD-9/10, and HCPCS
• Proficiency in Excel for managing and evaluating large claim datasets