Clinical Claims Review RN

TalentLNX LLC; United States; À distance; USD 70 000 - 95 000; Plein temps

Résumé du poste

TalentLNX LLC seeks a remote Clinical Claims Review RN to audit hospital claims line by line against medical records, ensuring charges are ordered, documented, and supported. The role blends acute care nursing judgment with chart auditing, coding, and revenue integrity in a fully remote, direct-hire setting.

The ideal candidate is an active RN with 5+ years in ICU/ER/OR, 1+ year in chart auditing or claims review, and familiarity with UB-04, CPT, HCPCS, and ICD-10.

Qualifications

• Active, unrestricted RN license.
• 5+ years of hospital RN experience in ICU/ED/OR or similar.
• 1+ year of chart auditing, claims review, coding, or revenue integrity.
• Familiarity with UB-04 forms, itemized bills, and revenue codes.
• Knowledge of CPT, HCPCS, and ICD-10 coding.
• Associate degree in nursing or higher.
• Proficiency with EMR and Excel.
• Ability to work independently in a remote, production-based setting.

Responsabilités

• Audit hospital claims line by line against medical records to validate billed charges.
• Apply clinical judgment to determine if procedures, supplies, meds, and devices were appropriate and documented.
• Validate surgical supplies and implants against operative/procedural documentation.
• Identify duplicate charges, unbundled services, quantity errors, and non-supported charges.
• Apply billing guidelines, revenue codes, coding standards, and policies to review findings.
• Research unfamiliar procedures and high-cost items to support determinations.
• Document audit conclusions clearly to support resolution, inquiries, and appeals.
• Meet quality, accuracy, and turnaround standards in a queue-based remote environment.
• Maintain HIPAA confidentiality at all times.

Connaissances

RN scope

ICU/ER/OR

Chart auditing

Remote work

Excel

MS Office

Formation

Associate degree in nursing

Outils

UB-04 knowledge

CPT coding

HCPCS coding

ICD-10 coding

Description du poste

We are seeking a remote Clinical Claims Review RN to join an established and growing clinical review team. In this role, you will combine acute care clinical judgment with hands on review experience to audit hospital claims line by line against the medical record, confirming that every charge, supply, implant, and medication billed is ordered, documented, and supported by the care provided. This position is a full time, direct hire opportunity and is fully remote.

This role is well suited for a registered nurse with a strong ICU, emergency, or operating room foundation who has already built experience in chart auditing, claims review, coding, utilization review, or revenue integrity. You understand how clinical care translates into hospital charges, and you are comfortable questioning and documenting findings when the two do not align. Training on internal systems, policies, and review workflows is provided. The ideal candidate is analytical, detail oriented, and thrives in a production based remote environment.

Responsibilities:

• Audit hospital claims line by line using the UB-04, itemized statement, and medical record to validate billed charges
• Apply clinical judgment to determine whether procedures, supplies, medications, and equipment billed were appropriate and supported by documentation
• Validate surgical supplies and implants against operative and procedural documentation
• Identify duplicate charges, unbundled services, quantity errors, routine services billed separately, and charges not supported by the record
• Apply billing guidelines, revenue codes, coding standards, and applicable policies to review findings
• Research unfamiliar procedures and high cost items to support accurate determinations
• Document audit conclusions clearly and accurately to support claim resolution, inquiries, and appeals
• Meet established quality, accuracy, and turnaround standards in a queue based work environment
• Maintain strict confidentiality of patient health information in line with HIPAA standards

Qualifications:

• Active, unrestricted Registered Nurse (RN) license
• 5+ years of hospital based RN experience in ICU, emergency department, operating room, or a similar high acuity procedural setting
• 1+ year of experience in chart auditing, claims or bill review, medical coding, utilization review, or revenue integrity
• Working knowledge of hospital billing, including UB-04 claim forms, itemized bills, and revenue codes
• Familiarity with CPT, HCPCS, and ICD-10 coding
• Associate degree in nursing or higher
• Proficiency with electronic medical records and Microsoft Office, including Excel
• Ability to work independently and manage a production based workload in a remote setting

Preferred Qualifications:

• Experience in itemized bill review, hospital bill audit, or claims auditing
• Cath lab, interventional radiology, trauma, or cardiac procedural experience
• Experience tracking and documenting surgical supplies and implants in the operating room
• Coding or revenue integrity certification such as CPC, CIC, CCS, CRIP, or CHRI
• Compact or multistate RN license

Schedule:

• Full time, direct hire
• Monday through Friday, standard daytime business hours
• Fully remote following a paid training period
• Reliable high speed internet and a private, HIPAA compliant home workspace required

Salary Range:

The salary range for this position is approximately $70,000 to $95,000 annually ($33.65 to $45.67 per hour), based on experience and qualifications.

Interview Process:

Selected candidates will participate in a multi step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer:

TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local law.