Medical Review II (Medicare)

broadwayventures; Deutschland; Remote; EUR 53.000 - 56.000; Vollzeit

Benefits dieser Stelle

401(k) and company match

PTO that grows the longer you stay

Health, Vision, Dental

Company provided Life Insurance andVol

Zusammenfassung

Broadway Ventures is seeking a licensed Registered Nurse to perform complex medical review of Medicare claims for Inpatient Rehabilitation Facility (IRF) services. This role conducts pre-claim review (PCR) determinations, evaluates Additional Documentation Request (ADR) responses, and communicates determinations directly to providers.

Work is production-driven and governed by strict contractual turnaround requirements. Broadway Ventures offers a comprehensive benefits package.

Qualifikationen

• Associate Degree in Nursing or graduate of an accredited School of Nursing.
• 2 years clinical experience.
• Active RN licensure in state hired, or active compact multistate RN license.
• Working knowledge of word processing software.
• Ability to work independently, prioritize effectively, and make sound decisions.
• Demonstrated customer service and organizational skills.
• Demonstrated oral and written communication skills.
• Analytical or critical thinking skills.
• Knowledge of Microsoft Excel, Access, or other spreadsheet/database software.

Aufgaben

• Perform complex medical review of Medicare claims for IRF services.
• Conduct pre-claim review determinations (PCR) and evaluate ADR responses.
• Communicate determinations directly to providers.
• Work is production-driven with strict contractual turnaround requirements.

Kenntnisse

Word processing

Independent work

Sound judgment

Customer service

Communication skills

Analytical thinking

Discretion with confidential data

Ausbildung

Associate Degree - Nursing, or Graduate of an accredited School of Nursing

Bachelor's degree - Nursing

Tools

Microsoft Office

Jobbeschreibung

At Broadway Ventures , we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation.

Pay Rate: $62,000-$65,000

Location: Remote

RN Medical Reviewer - Inpatient Rehabilitation Facility (IRF)

Position Summary

Broadway Ventures is seeking a licensed Registered Nurse to perform complex medical review of Medicare claims for Inpatient Rehabilitation Facility (IRF) services. This role conducts pre-claim review (PCR) determinations, evaluates Additional Documentation Request (ADR) responses, and communicates determinations directly to providers. Work is production-driven and governed by strict contractual turnaround requirements.

Minimum Qualifications

Education Level and Degree Type

• Associate Degree - Nursing, or Graduate of an accredited School of Nursing

Work Experience

• 2 years clinical experience

Skills and Abilities

• Working knowledge of word processing software
• Ability to work independently, prioritize effectively, and make sound decisions
• Good judgment skills
• Demonstrated customer service and organizational skills
• Demonstrated oral and written communication skills
• Analytical or critical thinking skills
• Ability to handle confidential or sensitive information with discretion

Software and Other Tools

• Microsoft Office

Licenses and Certificates

• Active RN licensure in state hired, OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC)

Preferred Qualifications

Education Level and Degree Type

• Bachelor's degree - Nursing, OR Graduate of an Accredited School of Nursing

Work Experience

• Preferred experience minimum 3 years RN clinical experience

Skills and Abilities

• Knowledge of spreadsheet and database software
• Ability to persuade, negotiate, or influence others
• Working knowledge of managed care and various current forms of health care delivery systems; strong clinical experience - home health, rehabilitation, and/or broad medical surgical experience
• Knowledge of Medicare and/or regulations/policies/instructions/provisions, home health, system/processing procedures for medical review
• Knowledge of or ability to learn specific criteria/protocol sets and the use of the same

Software and Other Tools

• Working knowledge of Microsoft Excel, Access, or other spreadsheet/database software

Broadway Ventures is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, protected veteran status, or any other status protected by applicable law.

Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).

The pay range shown is a good-faith estimate of the compensation Broadway Ventures reasonably expects to pay for this position at the time of posting. It is not a guarantee of any particular wage, salary, or total compensation. Actual pay offered depends on job-related factors, which may include skills, experience, education, certifications and licensure, geographic work location, contract funding and budget. For positions covered by the Service Contract Act, pay is also governed by the applicable Department of Labor wage determination, which the government may revise.

Some positions are posted in support of a contract proposal that has not yet been awarded. Where that is the case, the position and its final compensation are contingent upon award of the contract to Broadway Ventures and on the terms of the awarded contract, including any government-approved labor rates and the applicable wage determination.

Broadway Ventures offers a comprehensive benefits package. A general description of benefits is below.

• 401(k) and company match
• PTO that grows the longer you stay
• Health, Vision, Dental
• Company provided Life Insurance and Voluntary Life Insurance
• Short Term Disability and Long Term Disability