Medicare Claim Review Nurse | Fraud & Telework

Peraton

Oregon

Hybrid

USD 51,000 - 82,000

Full time

7 days ago

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Benefits offered by this job

Medical

Dental

Vision

Life

Health Savings Account

Short/Long Term Disability

EAP

Parental leave

401(k)

PTO

Company paid holidays

Job summary

Peraton seeks a Nurse Reviewer for SafeGuard Services to conduct medical record reviews and make informed payment decisions. You will support fraud investigations, identify issues, and refer cases for administrative action.

Remote work is available from anywhere in the United States. Applicants should have an RN license, 5+ years in the medical field, strong investigative and communication skills, and US citizenship; CPC is a plus.

Qualifications

5 years experience with BS/BA or 7 years with an Associates degree.
Experience in the medical field as a Registered Nurse or clinician.
Current nursing license.
Strong investigative skills and ability to review medical claims.
US citizenship is required.

Responsibilities

Conduct medical record reviews and apply clinical judgment to claim payment decisions.
Research medical claims data to identify problems and support fraud investigations.
Identify cases for administrative action and refer to law enforcement or overpayment recovery.
Respond to data requests and communicate findings clearly to stakeholders.
May be required to testify in court and present findings, with confidentiality maintained.