Registered Nurse Medical Claims Reviewer

Job Summary

A company is looking for a Medical Claims Reviewer - Remote.

Key Responsibilities:

• Conduct medical claim reviews for complex services, pre-authorizations, appeals, and coding accuracy
• Use established clinical guidelines to make coverage and reimbursement determinations
• Document medical rationale for claim approvals or denials and provide education to teams regarding medical reviews

Qualifications - What You Need to Succeed:

• Active, unrestricted RN license in the U.S. or active compact multistate RN license
• Associate's degree in a related field or graduate of an Accredited School of Nursing
• Minimum two years of clinical nursing experience
• Medicare Part B and DME claims experience preferred
• Intermediate computer proficiency with multitasking capabilities preferred