Remote Medicare Medical Review Nurse (AI-Driven)

ePATHUSA, Inc.; Clive (IA); Remote; USD 80,000 - 110,000; Full time

Job summary

ePATHUSA, Inc. is seeking a Registered Nurse for a fully remote, Medicare-focused medical record review role. You will evaluate Part A and B claims, ensure coding accuracy, and determine compliance with national and local coverage determinations.

The position supports AI-driven review processes and requires independent, detail-oriented work with high accuracy. Responsibilities include validating AI outputs, translating policy documents into structured rules, and collaborating with program

Qualifications

• Knowledge of ICD-9-CM, ICD-10, CPT-4 and HCPCS coding.
• Experience with Medicare Parts A and B policy and associated claims.
• Ability to read, analyze and interpret physician documentation.
• Strong research skills in Medicare, Medicaid and local healthcare regulations.

Responsibilities

• Review Medicare Part A and Part B payment policies for services and equipment.
• Assess AI-assisted policy translation accuracy for compliance determinations.
• Monitor for fraud, waste and abuse indicators in claims data.
• Maintain productivity and accuracy standards (98% IRR).
• Support program and technical teams in meeting deliverables.

Skills

ICD coding

CPT/HCPCS

Medicare policies

Medical record review

Documentation analysis

Research skills

Education

Bachelor's Degree in Nursing

BSN preferred

Tools

EMR software

InterQual/Milliman guidelines

Job description

ePATHUSA, Inc. is seeking a Registered Nurse for a fully remote, Medicare-focused medical record review role. You will evaluate Part A and B claims, ensure coding accuracy, and determine compliance with national and local coverage determinations.

The position supports AI-driven review processes and requires independent, detail-oriented work with high accuracy. Responsibilities include validating AI outputs, translating policy documents into structured rules, and collaborating with program