Remote Medical Review Nurse (RN)
A company is looking for a Medical Review Nurse (RN) to support medical claim and internal appeals review activities remotely.
Key Responsibilities
ā¢ Facilitates clinical reviews of medical claims and appeals to ensure medical necessity and accurate billing
ā¢ Validates medical records and claims for appropriate reimbursement and resolves escalated complaints regarding utilization management
ā¢ Prepares and presents cases for administrative hearings and serves as a clinical resource for utilization management inquiries
Required Qualifications
ā¢ At least 2 years of clinical nursing experience, including 1 year in utilization review or medical claims review
ā¢ Active and unrestricted Registered Nurse (RN) license in the state of practice
ā¢ Experience with ICD-10, CPT coding, and HCPC regulations
ā¢ Analytic and decision-making skills with experience in relevant state and federal regulations
ā¢ Proficiency in Microsoft Office suite and applicable software programs
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Key Responsibilities
ā¢ Facilitates clinical reviews of medical claims and appeals to ensure medical necessity and accurate billing
ā¢ Validates medical records and claims for appropriate reimbursement and resolves escalated complaints regarding utilization management
ā¢ Prepares and presents cases for administrative hearings and serves as a clinical resource for utilization management inquiries
Required Qualifications
ā¢ At least 2 years of clinical nursing experience, including 1 year in utilization review or medical claims review
ā¢ Active and unrestricted Registered Nurse (RN) license in the state of practice
ā¢ Experience with ICD-10, CPT coding, and HCPC regulations
ā¢ Analytic and decision-making skills with experience in relevant state and federal regulations
ā¢ Proficiency in Microsoft Office suite and applicable software programs
Apply tot his job
Apply To this Job