Remote Medical Policy & Coding Review Nurse

General Dynamics Information Technology, Inc.; Virginia (MN); Hybrid; USD 85,000 - 115,000; Full time

Job summary

General Dynamics Information Technology, Inc. is seeking a Medical Policy Review Nurse to support the World Trade Center Health Program. You will align clinical documentation, coding, and medical policy to determine coverage and maintain claims integrity.

Key duties include evaluating CPT/HCPCS/ICD coding against policy, collaborating with medical directors and utilization teams, and supporting audits with a focus on accuracy and regulatory compliance onsite or remotely.

Qualifications

• Education: Associate degree in Nursing required; bachelor’s degree preferred.
• Experience: 5+ years in medical coding, medical policy, utilization management, or clinical documentation review.
• Certifications: CPC, CCS, CCA, CRC, or equivalent preferred.

Responsibilities

• Lead evaluation of CPT, HCPCS, ICD‑10‑CM/PCS, MS‑DRG, revenue codes, and modifiers against clinical evidence and policy.
• Collaborate with Medical Directors, Utilization Management, coding/compliance, product teams, and policy analysts.
• Drive high‑quality coding and coverage outcomes; support audits and prior authorization discussions.

Skills

Clinical Documentation

Documentation Review

Medical Billing and Coding

Medical Coding

Medical Documentation

Education

Associate degree in Nursing

Bachelor’s degree preferred

Job description

General Dynamics Information Technology, Inc. is seeking a Medical Policy Review Nurse to support the World Trade Center Health Program. You will align clinical documentation, coding, and medical policy to determine coverage and maintain claims integrity.

Key duties include evaluating CPT/HCPCS/ICD coding against policy, collaborating with medical directors and utilization teams, and supporting audits with a focus on accuracy and regulatory compliance onsite or remotely.