Remote RN Medical Reviewer – Medicare Claims

J29, Inc; Oregon; Híbrido; USD 55.000 - 62.000; A tiempo parcial

Descripción de la vacante

J29, Inc. is seeking a Medical Reviewer, RN for a remote, temporary seasonal position with an anticipated duration of up to six months.

The role focuses on reviewing Medicare FFS claims to determine proper payments and documenting findings in accordance with CMS rules. Requirements include an active Registered Nurse license, CPC/CCS or equivalent, and 5+ years of medical coding/billing experience; 3+ years of remote work experience and familiarity with low-code/no-code case management systems

Formación

• 5+ years of direct medical coding or medical billing experience in a healthcare environment.
• 3+ years in a productivity-based claims or case working environment.
• 3+ years working remotely with various technology systems.
• 3+ years of Medicare Fee For Service (FFS) experience in medical coding roles.
• Active Medical Coding Certification (CPC, CCS or equivalent).
• Experience with low-code, no-code case management systems is preferred but not required.

Responsabilidades

• Review Medicare FFS claims (Part A/B, DMEPOS, Home Health/Hospice) to assess overpayments/underpayments.
• Apply Medicare policies and guidelines per National and Local Coverage Determinations and CMS rules.
• Document clear, accurate findings for each claim.
• Participate in dispute resolution with supporting documentation.
• Support QA through audits and ongoing training; ensure CMS security and privacy standards.
• Collaborate with key personnel to ensure consistency and process improvement.

Conocimientos

CMS policy knowledge

Remote work experience

Educación

Registered Nurse license

Medical Coding Certification (CPC/CCS)

Herramientas

Low-code / no-code case management

Descripción del empleo

J29, Inc. is seeking a Medical Reviewer, RN for a remote, temporary seasonal position with an anticipated duration of up to six months.

The role focuses on reviewing Medicare FFS claims to determine proper payments and documenting findings in accordance with CMS rules. Requirements include an active Registered Nurse license, CPC/CCS or equivalent, and 5+ years of medical coding/billing experience; 3+ years of remote work experience and familiarity with low-code/no-code case management systems