Remote Senior Nurse Reviewer: Medical Claims & Coding
Gainwell Technologies
- Remote job
Gainwell Technologies is hiring a Senior Nurse Reviewer for a remote, home-based role across the continental US. The position focuses on reviewing medical claims, UB-04 forms, and itemized bills to ensure accuracy and proper billing, with emphasis on clinical review expertise and coding knowledge. You will verify charges, perform utilization reviews, mentor new reviewers, and stay current with clinical and coding guidelines while maintaining quality and production standards. #J-18808-Ljbffr Gainwell Technologies
$78k - $99.2k
...partner is looking for a Senior Nurse Reviewer based in the United... ...quality and claims accuracy by applying... ...expertise to complex medical reviews. As a Senior... ..., and feedback. This remote opportunity combines... ...clinical review criteria, coding guidelines, and relevant...Remote workSeniorClaimsFull timeWork from homeFlexible hours$95k - $110k
...It takes great medical minds to create powerful solutions... ...individual for a DRG Nurse Reviewer Appeals and Hearings... ...approved clinical and coding guidelines and... ...perform reviews of multiple claim types to provide a flexible... ...in this role Remote (Work from Home) Up...Remote workClaimsFull timeWork from homeRelocation packageFlexible hours- ...HumanaPosted: Humana Inc. is seeking a Senior Medical Coding Outpatient Auditor to lead coding-focused... ....The role involves researching claims anomalies, applying CPT/HCPCS guidelines... ...analytics teams to improve audit strategies. Remote work with occasional travel is possible...Remote workSeniorClaims
$34 per hour
...The kozmetickesluzby.vecnakraska.sk - Jobboard is seeking a Sr. Medical Review Nurse for a remote position based in Baltimore, MD. This role involves comprehensive reviewing of medical records, coding practices, and working with stakeholders to ensure compliance and accuracy...Remote workSeniorClaimsHourly payFull time- Providence Swedish is seeking a claims specialist to remotely prepare, edit and submit insurance claims to Medicare, Medicaid, L&I, VA... ...errors for process improvements. The role requires medical terminology or coding training and at least 1 year in hospital regulatory...Remote jobSeniorClaims
- This is a remote role.Responsible for preparation, editing... ...and timely insurance claims (electronic and manual)... ...and corrected claims. Reviews and resolves billing... ...Conduct research / analyze coding errors, document... ...qualifications:Coursework/Training: Medical terminology and medical...Remote workSeniorClaimsMinimum wageLocal areaShift work
- ...Functions Monitor coding backlogs,... ...workflows. Serve as a senior coding resource... ...analysis, root-cause review, and development... ...years of professional medical coding experience,... ...records or claims. Accuracy is critical... .... This is a remote position Physical...Remote workSeniorClaimsWork at office
- ...Senior HIM & Coding Consultant PCG Consulting International... ...clinical documentation, medical coding, and revenue cycle... ...accuracy, support claim reconstruction, and identify... ...Responsibilities Review clinical documentation... ...Position Primarily Remote Occasional onsite...Remote workSeniorClaims
$45 - $55 per hour
...Senior Analytics Engineer, Healthcare Informatics Location: Remote within approved states: Alabama, Florida, Georgia... ...analytics code while preserving business... ...experience analyzing Medicare claims, provider, or... ...databases Knowledge of medical terminology and coding...Remote workSeniorClaimsHourly payWork at office- ...Experienced in hospital claims adjudication, the full-time remote Senior Claims Analyst will analyze hospital... ...and identify discrepancies Review high-cost claims to uncover... ...Hospital/Surgical/ICU Nursing background (RN) with clinical coding experience 5+ years of experience...Remote workSeniorClaimsFull time
- Overview The Senior Data Analyst serves as a key resource... ...reporting development.Remote = Individuals in this... ...analyzing clinical, claims, eligibility, financial... ...programming code (e.g. SAS, R, Python, SQL... ...healthcare, including medical claims coding, relationships...Remote workSeniorClaimsFull time
$46.99k - $112.2k
...Senior Investigator, Aetna Special Investigations Unit... ...prevent payment of aberrant claims submitted to the Medicaid... ...for both clinical and legal review Collaborate with Medical Directors on clinical issues... ...Working knowledge of medical coding; CPT, HCPCS, ICD10 ~...Remote workSeniorClaimsHourly payFull timeTemporary workWork at officeLocal area- ...innovation stalls. As a Senior Health Economist at... ...standards for study design, code review, and client... ...infrastructure (e.g., automated claims data pipelines in... ...including deep knowledge of medical billing, CPT/ICD... ...ModelWe believe that remote work and in-person work...Remote workSeniorClaimsWork at officeLocal areaWorldwide3 days per week
$24 - $43 per hour
...Senior Medical Coder Optum is a global organization that delivers... ...Coder performs concurrent review of FFS coding rules, ensuring all CPT and... ...functions within charge review, claim edits, and denials and play... ..., 8am - 5pm Location: Remote Nationwide You will...Remote jobSeniorClaimsHourly payMinimum wageFull timeWork experience placementLocal areaMonday to Friday$24 - $28 per hour
...oriented and analytical Senior Revenue Cycle... ...Location: Northbrook, IL (Remote work is not an option)... ...balances. Analyze and resolve claim denials , including root... ...closely with billing, coding, and payer teams to ensure... ....). Certification in medical billing/coding (e.g.,...Remote workSeniorClaimsFull timeMonday to Friday$24 - $43 per hour
...Senior Inpatient Medical Coder/Acute Edits And Denials Claims Analyst Optum is a global organization that... ...Analyst, you will work remotely to correct, CCI, Medically... ...addition to periodic coding. You will also work... ...involving payer and compliance reviews ~ Other duties as...Remote jobSeniorClaimsHourly payMinimum wageFull timeWork experience placementLocal area$54.1k - $77.3k
...It takes great medical minds to create powerful solutions... ...for an Inpatient Coding Auditor, Senior Associate who is... ...for performing coding reviews of medical records and... ...reviews of multiple claim types to provide a flexible... ...in this role • Remote (work from home)...Remote workSeniorClaimsFull timeContract workWork from homeFlexible hours$59.81k - $129.59k
JOB DESCRIPTION Provides senior-level analytical support for Medical Economics initiatives through the extraction,... ...trends through the integration of claims, provider, membership, authorization... ...PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC,...Remote jobSeniorClaimsWork experience placementWork at office$32k - $42k
...Position : Senior Healthcare Claims Processor Location : Remote, Eastern Standard Time (EST) based... ...specializes in processing, reviewing, and analyzing claims,... ...~ Healthcare claims, coding, billing, auditing,... ...certification. ~3-5+ years of medical coding knowledge...Remote workSeniorClaimsFull timeContract work- ...DESCRIPTION Job Summary Provides senior level analyst support for medical economics analysis activities,... ...relationship between authorization and claim, utilization management reporting... ...and experience. Expert in SQL coding through any platform. Job will require...Remote workSeniorClaimsFull timeWork experience placementWork at office
- UnitedHealth Group seeks a Senior Medical Coder to perform concurrent review and ensure accurate CPT and E/M coding for maximum reimbursement and... ...functions within charge review, claim edits, and denials, helping... ...Friday, 8am-5pm. Location: Remote Nationwide—telecommute from...Remote jobSeniorClaimsMonday to Friday
$105k - $133k
...Position Overview The Senior Content Ideation... ...focused on Itemized Bill Review and DRG Validation... ...under the Expert Claim Review (ECR) suite... ...for DRG Coding and Clinical Validation... ...date approved Zelis medical coding sources for... ...foster a hybrid and remote friendly culture, and...Remote workSeniorClaimsFull timeWork at officeLocal areaFlexible hours- Optum is seeking a Senior Medical Coder to perform concurrent review of FFS coding rules, ensuring CPT and E/M codes are accurately... ...functions within charge review, claim edits, and denials to sustain... ...Monday-Friday, 8am-5pm. Location: Remote Nationwide. You will apply ICD-1...Remote jobSeniorClaimsMonday to Friday
$51k - $82k
...performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and... ...and abuse. We are looking to add a Nurse Reviewer to our SGS team of talented professionals... ...and to apply sound clinical judgment to claim payment decisions. Responsibilities may...Remote workClaimsContract workShift workNight shift- ...Senior Medical Billing Specialist Join Hire Hangar and... ...career. Location: Remote Time Zone: US Time... ...ensures accurate, timely claims submission and takes primary... ..., eligibility, coding, coordination of benefits... ...in quality assurance reviews of clinical documentation...Remote workSeniorClaims
- ...insurance defense Firm, looking for a Senior Insurance Defense Attorney to... ...experience. This role is remote. \n \n Requirements: \n... ...defense cases, from initial claim evaluation to final resolution... ...\n Full Benefits offered - Medical, Dental, etc. Flexible work schedule...Remote workSeniorClaimsFlexible hours
- Commence is seeking a Nurse Reviewer to perform complex medical record reviews of Medicare Part A/B and DMEPOS claims. The role requires clinical judgment to assess payment validity... ...to CMS guidelines. The position is remote, offering flexibility while demanding high...Remote jobClaims
- A healthcare organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The role involves examining claims, maintaining... ...This position offers a chance to work in a remote setup with competitive hours. Benefits include...Remote jobClaims
- ...the Supervisor of Outpatient Coding, The OP Senior Coder is a vital... ...matter expert, educator, QA reviewer, and also focuses daily efforts... ...cases and resolving coding claims edits to adhere to billing deadline... ...in anatomy and physiology, medical terminology, pathophysiology...Remote jobSeniorClaims
- ...Managing high-severity, complex insurance claims, the full-time Senior Claims Consultant will focus on coverage analysis, policy... ...and Professional Liability claims in a fully remote setting. Key Responsibilities Review and interpret EPL, Professional Liability, BOP, and...Remote workSeniorClaimsFull time
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