Remote RN Claims Reviewer - Clinical Dispute Analyst

Capitol Bridge, Llc; Sector Toledo (PR); Remoto; USD 30.000 - 43.000; Tempo pieno

Descrizione del lavoro

Capitol Bridge Puerto Rico is seeking an experienced Registered Nurse to independently review healthcare claim disputes in a fully remote role. You will evaluate documentation, identify missing information, and determine the medical necessity and appropriateness of care, producing clear determinations and narratives for health plans and providers.

Required is an active Puerto Rico RN license and at least five years of direct patient care.

Competenze

• Active, unrestricted RN license valid for Puerto Rico.
• At least five years of direct patient care experience.
• Strong English writing and documentation skills.

Mansioni

• Review documentation in healthcare claim disputes and determine information gaps.
• Identify missing clinical or claim documentation and follow procedures to obtain it.
• Evaluate medical necessity and appropriateness of care within the reviewer’s scope.
• Draft clear, professional determination narratives and communicate findings to stakeholders.

Conoscenze

Clinical judgment

Written English

Documentation review

Independent work

Stakeholder communication

Formazione

Registered Nurse license

Strumenti

CPT coding

ICD-10-CM

EOB review

Descrizione del lavoro

Capitol Bridge Puerto Rico is seeking an experienced Registered Nurse to independently review healthcare claim disputes in a fully remote role. You will evaluate documentation, identify missing information, and determine the medical necessity and appropriateness of care, producing clear determinations and narratives for health plans and providers.

Required is an active Puerto Rico RN license and at least five years of direct patient care.