Remote RN Medical Claims Auditor - SNF/MDS Expert

Machinify; Oregon; Ibrido; USD 90.000 - 105.000; Tempo pieno

Descrizione del lavoro

Machinify, a leading healthcare intelligence company, is seeking a Medical Review Nurse II - SNF/MDS to join a remote audit team. You will perform retrospective and prepayment audits on claims for Government and Commercial Payers in skilled nursing facility settings.

This exempt, salaried role requires RN licensure, 5+ years nursing experience, and strong knowledge of ICD-9/ICD-10, MDS/RAI, and UB-04. You will document findings, support appeals, and collaborate with clients and colleagues to

Competenze

• Active unrestricted RN license required.
• Not currently sanctioned or excluded from Medicare program by OIG.
• Minimum of five (5) years diversified nursing experience in inpatient or outpatient settings.
• One (1) or more years' experience with MDS/RAI process.
• One (1) or more years' experience performing medical records reviews.
• One (1) or more years' experience in health care claims with ICD-9/ICD-10 guidelines and MDS/RAC process.
• Understanding of UB-04 and its application to MDS billing.

Mansioni

• Audit claims for medically appropriate services in SNF settings.
• Document findings referencing policies and rules.
• Generate letters detailing audit findings.
• Support audit findings during appeals when requested.
• Collaborate with audit team and clients to improve workflows.
• Keep current with medical practice, technology, and regulatory changes.
• Assist with QA and training of team members.

Conoscenze

Active RN license

MDS/RAI experience

ICD-9/ICD-10 coding

MS Office proficiency

Time management

Communication skills

Remote work

Formazione

Nursing degree

Strumenti

UB-04 familiarity

Descrizione del lavoro

Machinify, a leading healthcare intelligence company, is seeking a Medical Review Nurse II - SNF/MDS to join a remote audit team. You will perform retrospective and prepayment audits on claims for Government and Commercial Payers in skilled nursing facility settings.

This exempt, salaried role requires RN licensure, 5+ years nursing experience, and strong knowledge of ICD-9/ICD-10, MDS/RAI, and UB-04. You will document findings, support appeals, and collaborate with clients and colleagues to