Pennsylvania Licensed Lead Nurse

Job Summary

A company is looking for a Claim Payment Policy Lead Nurse (RN) - remote (PA/NJ/DE).

Key Responsibilities

• Lead cross-functional collaborations to generate and implement innovative medical cost savings ideas
• Monitor industry trends and regulatory changes to ensure compliance with organizational goals
• Develop and maintain claims payment and medical policies in accordance with recognized practices and mandates

Required Qualifications

• Bachelor's degree in a relevant discipline or equivalent work experience
• Current coding certification (CCS, CPC, RHIA, RHIT) or a combination of coding certification and clinical licensure (e.g., RN)
• Minimum of five years of related work experience in revenue cycle management and medical coding
• Knowledge of healthcare reimbursement concepts, industry terminology, and regulatory guidelines
• Familiarity with Medicare rules and regulations