Remote CMS/RAC Medical Review Nurse

Machinify; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

Machinify seeks a Medical Review Nurse to perform CMS/RAC government audits remotely across the US. The role emphasizes retrospective and prepayment claim reviews, strong regulatory knowledge, and collaboration with a multi-site team.

RAC certification is preferred, and ongoing professional development is expected. The candidate will audit inpatient and outpatient claims, document findings, and prepare audit letters while supporting appeals and QA efforts in a fast-paced remote environment.

Qualifications

• Active unrestricted RN license in good standing.
• Five years of diversified nursing experience.
• One year or more of medical records review experience.
• Experience with ICD-9/ICD-10, CPT/HCPCS coding and DRG in billing.
• Experience with health care claims and insurance company or hospital billing.
• RAC certification preferred.

Responsibilities

• Audit claims for medically appropriate services in inpatient and outpatient settings with appropriate guidelines.
• Document findings referencing policies and rules.
• Generate letters articulating audit findings.
• Support findings during appeals if requested.
• Collaborate with audit team to identify vulnerabilities and cases for review.
• Assist with QA and training and with policy development.

Skills

Active unrestricted RN license

Government audits experience

ICD-9/ICD-10 coding

CPT coding knowledge

Utilization management knowledge

Strong communication

Remote work ability

Education

Nursing degree (RN)

Tools

Case management system

Job description

Machinify seeks a Medical Review Nurse to perform CMS/RAC government audits remotely across the US. The role emphasizes retrospective and prepayment claim reviews, strong regulatory knowledge, and collaboration with a multi-site team.

RAC certification is preferred, and ongoing professional development is expected. The candidate will audit inpatient and outpatient claims, document findings, and prepare audit letters while supporting appeals and QA efforts in a fast-paced remote environment.