Remote RN Claims Reviewer

Federal Hearings And Appeals; United States; A distancia; USD 65.000 - 95.000; Jornada completa

Descripción de la vacante

Federal Hearings And Appeals is seeking a Remote RN Claims Reviewer to evaluate medical claims, determine approvals, denials, and appeals. You will review medical records, apply Medicare regulations, and cite supporting documentation from the case file.

Responsibilities include drafting narrative decisions, coding awareness, and maintaining professional licensure with a strong emphasis on accuracy and regulatory compliance. Travel is limited and training sessions are available as needed.

Formación

• Must possess a current, unrestricted State RN license.
• Minimum 1+ year clinical experience; coding or chart review preferred.
• Professional coding certification preferred.
• Strong knowledge of Medicare regulations, CPT/HCPCS/ICD-10 codes.
• Ability to support findings with analytical, written and oral skills.

Responsabilidades

• Provide timely review and determination of medical claims, including prior authorization and appeals.
• Analyze medical records related to the case file and apply applicable regulations.
• Review LCD/NCD and other policies; cite regulatory back-up documentation.
• Formulate narrative decisions and adjudicate claims based on records.
• Maintain licensure and participate in FHAS training sessions on site or remotely.
• Complete IRR surveys and maintain a 97%+ quality score.

Conocimientos

Analytical skills

Written communication

Oral communication

Team player

Organizational skills

People skills

PC proficiency

Herramientas

PC software

Descripción del empleo

Federal Hearings And Appeals is seeking a Remote RN Claims Reviewer to evaluate medical claims, determine approvals, denials, and appeals. You will review medical records, apply Medicare regulations, and cite supporting documentation from the case file.

Responsibilities include drafting narrative decisions, coding awareness, and maintaining professional licensure with a strong emphasis on accuracy and regulatory compliance. Travel is limited and training sessions are available as needed.