Registered Nurse – Medical Claims Reviewer (FES Claims) - RNMCR

NavitsPartners; Tucson (AZ); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated Registered Nurse to join their team as a Medical Claims Reviewer. This remote position offers the opportunity to leverage your clinical expertise in reviewing and adjudicating emergency medical claims. The role requires a keen eye for detail and strong analytical skills, as you'll be responsible for ensuring accuracy and compliance with regulations. If you're self-directed and passionate about making a difference in healthcare, this is the perfect opportunity for you.

Qualifications

• Must possess an active RN license in Arizona.
• BLS certification required prior to start.

Responsibilities

• Review emergency medical claims for accuracy and coding.
• Apply InterQual criteria and relevant regulations.
• Analyze data for trends and reporting.

Skills

Clinical Judgment

Claims Processing

Compliance Knowledge

Data Analysis

Education

Active RN License (Arizona)

BLS Certification

Tools

CPT Coding

HCPCS Coding

ICD-9 / 10 Coding

Job description

Job Title : Registered Nurse – Medical Claims Reviewer (FES Claims)

Location : Remote (occasional onsite training may be required)

Duration : 13 Weeks

Pay Type : Contract

Overview :

Seeking an experienced RN to review and adjudicate FES 1500 emergency medical claims. This remote role requires strong clinical judgment, familiarity with claims processing, and compliance knowledge. Candidates must be self-directed and detail-oriented.

Responsibilities :

Review emergency medical claims for accuracy, coding, and medical necessity

Apply InterQual criteria, CCI edits, and relevant regulations (AHCCCS, CMS)

Collaborate on second-level reviews and special projects

Analyze data for trends, reporting, and cost savings

Requirements :

Active RN license (Arizona)

BLS certification

Arizona Fingerprint Clearance Card (prior to start)

Proficiency in CPT, HCPCS, ICD-9 / 10

Knowledge of managed care, InterQual, and claim adjudication

Personal laptop (remote access provided)

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Registered Nurse Medical • Tucson, Arizona, United States