Remote Medical Review Nurse II - Clinical Validation

Performant Healthcare, Inc.; United States; Remote; USD 69,300 - 78,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401(k) savings plans

Paid family leave

Paid holidays

Sick and vacation time

Job summary

A healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial Payers. The position requires an active RN license and a minimum of five years nursing experience. Responsibilities include auditing claims and documenting findings, all in a remote work environment. This role offers a competitive salary range of $69,300 - $78,000 and comprehensive benefits.

Qualifications

• Active unrestricted RN license in good standing is required.
• Minimum of five years diversified nursing experience providing direct care.
• One or more years' experience performing medical records review.

Responsibilities

• Conduct medical claims audit reviews for Government and Commercial Payers.
• Document findings with respect to policies and guidelines.
• Support findings during the appeals process as necessary.

Skills

Utilization management systems

ICD-9 coding

ICD-10 coding

CPT-4 coding

HCPCS coding

Excellent communication skills

Independent work

Documenting findings

Education

Active unrestricted RN license

Tools

Case management system

Job description

A healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial Payers. The position requires an active RN license and a minimum of five years nursing experience. Responsibilities include auditing claims and documenting findings, all in a remote work environment. This role offers a competitive salary range of $69,300 - $78,000 and comprehensive benefits.