Bilingual Registered Nurse

AppleOne Employment Services; San Juan (PR); A distancia; USD 24.000 - 34.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work

Descripción de la vacante

AppleOne Employment Services is seeking a Bilingual Registered Nurse for a remote temp-to-hire role focused on clinical claims review in healthcare services. The candidate should review claims against medical records, ensure reimbursement policy compliance, and provide clear clinical explanations.

Qualified applicants include PR-licensed RNs or coding credential holders (CPC, CPC-A, CIC, COC, CPMA, CCS). Remote work with collaboration and ongoing professional development are emphasized.

Formación

• Active Puerto Rico Registered Nurse license or applicable coding certification.
• Strong attention to detail and analytical thinking.
• Experience interpreting medical records, claims data and reimbursement requirements.
• Ability to communicate clinical findings clearly in a remote environment.
• Bilingual communication skills suitable for a professional healthcare setting.

Responsabilidades

• Perform clinical reviews of professional or facility claims vs medical records to determine support.
• Maintain departmental standards for productivity, accuracy, and documentation.
• Provide clear clinical logic to providers and internal teams when determinations require explanation.
• Investigate, recover, and resolve claims for health plans, commercial customers, and government entities.
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract requirements.
• Participate in internal meetings and support process improvements across the team.

Conocimientos

Bilingual communication

Attention to detail

Analytical thinking

Problem-solving

Remote work communication

Educación

PR RN license

Coding certification (CPC/CPC-A/CIC/COC/CPMA/CCS)

Descripción del empleo

Job Summary

We are seeking a Bilingual Registered Nurse for a remote temp-to-hire opportunity in the healthcare services industry supporting clinical claims review. This role is ideal for a licensed Registered Nurse in Puerto Rico or a certified coding professional who is detail-oriented, analytical, and interested in applying clinical knowledge outside of direct patient care. In this position, you will review claims against medical records, evaluate whether services are supported, and help ensure compliance with reimbursement, contract, state, and federal guidelines. This opportunity offers structured expectations, supportive leadership, knowledgeable internal teams, and a collaborative remote environment focused on accuracy, quality, and continuous improvement. Candidates can expect a professional healthcare operations setting where clear communication, teamwork, and process consistency are valued. This is an excellent opportunity to build experience in clinical review, claims resolution, healthcare compliance, and documentation quality while working with a team committed to performance standards and professional development.

Key Responsibilities

• Perform clinical reviews of professional or facility claims compared with medical records to determine whether claims are supported or unsupported.
• Maintain departmental standards for productivity, accuracy, documentation, and clinical review quality.
• Provide clear clinical logic to providers and internal teams when claim determinations require explanation.
• Investigate, recover, and resolve claims for health plans, commercial customers, and government entities.
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract requirements.
• Participate in internal customer meetings, provide feedback, and support continuous improvement across team processes.

Compensation and Benefits

• Pay rate: $21 per hour.
• Job type: Temp-to-hire.
• Work arrangement: Remote.
• Location: San Juan, PR.

Required Qualifications and Skills

• Conduct clinical case reviews using medical records, claims data, and applicable documentation standards.
• Investigate claims issues and support recovery, resolution, and compliance processes.
• Document findings clearly while maintaining data integrity, data security, and process accuracy.
• Collaborate with internal teams to improve communication, workflow, and department relationships.
• Active Puerto Rico Registered Nurse license or applicable coding certification.
• Accepted certifications may include CPC, CPC-A, CIC, COC, CPMA, or CCS.
• Less than 1 year of experience may be considered if licensing or certification requirements are met.
• Demonstrated computer proficiency and ability to work accurately in healthcare systems and documentation tools.
• Ability to interpret medical records, claims information, reimbursement requirements, and compliance guidelines.
• Strong attention to detail, analytical thinking, and problem-solving skills.
• Ability to communicate clinical findings clearly and professionally in a remote work environment.
• Bilingual communication skills appropriate for a professional healthcare setting.

Preferred Qualifications

• Experience reviewing healthcare claims, medical records, or clinical documentation.
• Familiarity with health plan operations, claims recovery, reimbursement policies, or government healthcare programs.
• Prior remote work experience in a healthcare, clinical review, coding, or claims environment.

Equal Opportunity Employer / Disabled / Protected Veterans

The Know Your Rights poster is available here: https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here: https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program. https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.