Remote Medical Reviewer II RN Claims & Coding

BlueCross and BlueShield of South Carolina; United States; Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings plan with comp

Life Insurance

Paid Time Off (PTO)

Education Assistance

Job summary

BlueCross BlueShield of South Carolina is seeking an experienced RN to perform medical claim reviews remotely, leveraging clinical information and established guidelines. This full-time role supports medical claims and utilization practices during our standard business hours.

Applicants must have an Associate's degree in a related field, an active RN license, and at least 2 years of clinical experience, with proficiency in Microsoft Office.

Qualifications

• Associate's degree in a related field is required.
• Graduate of Accredited School of Nursing.
• 2 years clinical experience required.
• Excellent verbal and written communication, analytical skills, and ability to handle confidential information.

Responsibilities

• Performs medical claim reviews using clinical information and established guidelines.
• Makes charge payment determinations based on guidelines.
• Determines medical necessity and coverage decisions.
• Documents rationale for payments or denials and educates staff as needed.
• Participates in quality control activities.

Skills

RN License

Independent decision making

Customer service

Oral and written communication

Analytical thinking

Education

Associate's in a related field

Graduate of Accredited School of Nursing

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking an experienced RN to perform medical claim reviews remotely, leveraging clinical information and established guidelines. This full-time role supports medical claims and utilization practices during our standard business hours.

Applicants must have an Associate's degree in a related field, an active RN license, and at least 2 years of clinical experience, with proficiency in Microsoft Office.