Remote RN Clinical Review Specialist (Billing & Claims)
Texas Health Institute
- Remote job
Optum is hiring a Clinical Review Clinician to act as a subject matter expert for itemized bill reviews and hospital facility bills. The role includes documenting, researching, and identifying adjustments needed for payment as part of a team preparing Forensic Reviews for clients. Responsibilities include performing Forensic Reviews, reviewing medical records, and ensuring HIPAA privacy standards. This role offers telecommuting from anywhere in the U.S. #J-18808-Ljbffr Texas Health Institute
- Optum is hiring a Clinical Review Clinician to act as a subject matter expert for itemized bill reviews and hospital facility bills. The role includes documenting, researching, and identifying adjustments needed for payment as part of a team preparing Forensic Reviews for...Remote jobClaims
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims, documenting determinations and maintaining screening criteria. The role supports telecommuting from anywhere in the U.S. and requires...Remote jobClaimsWork at office
$86.8k - $124k
...development. Summary The Clinical Policy Specialist – Itemized Bill Review is responsible for the... ...facility billing, UB-04 claim processing, itemized bill... ...~ Active, Unrestricted RN license from the United... ...this role Location: Remote (U.S.-based) Travel: Up...Remote workClaimsFull timeFlexible hours- UnitedHealth Group is seeking a Clinical Review Clinician to serve as a subject matter expert for itemized bill reviews and hospital facility bill analysis. You will document... ...for clients. Role involves understanding claim review processes, medical record review, and applicable...Remote jobClaims
- J29, Inc. is seeking a Medical Reviewer, RN Coder for a remote, temporary assignment. The role is expected... ...and focuses on reviewing Medicare FFS claims via automated and manual processes to... ..., with at least 5 years of coding or billing experience and 3+ years in remote,...Remote jobClaimsTemporary work
- UnitedHealth Group seeks a Clinical Review Clinician to analyze itemized hospital bills and document adjustments for forensic reviews... ...requires clinical experience, RN or LPN license, and bill review knowledge. You will support claims through research and QA until client...Remote jobClaims
- UnitedHealth Group seeks a Clinical Review Clinician to serve as the subject matter expert for itemized bill reviews and analysis of hospital facility bills. You will document... ...policy framework and must understand the claim review process, clinical review, medical record...Remote jobClaims
- UnitedHealth Group's Optum is seeking a Clinical Review Clinician to act as a subject matter expert in itemized bill reviews and hospital facility bills. You will document and research adjustments for Forensic Reviews for specific clients. This role offers telecommuting...Remote job
- UnitedHealth Group is seeking a Clinical Review Clinician to perform forensic reviews of hospital facility bills and document adjustments with clinical accuracy. You will analyze charge details, compare to guidelines, and participate in negotiations and appeals within...Remote job
$26.14 - $56.64 per hour
...needed for the Medical Review Nurse: Registered... ...least 2 years of clinical experience as a... ...review, medical claims review, claims auditing... ...guidelines, billing and coding regulations... ...Registered Nurse (RN). License must be... ...Medical Audit Specialist (CMAS), Certified...Remote jobClaimsHourly payWork experience placementWork at officeMonday to Friday$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers care... ...matter expert for itemized bill reviews and analyzing hospital... ...comprehensive understanding of the claim review process including... ...degree ~ Active and unrestricted RN license OR LPN in the state of...Remote workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area$29 - $52 per hour
...Program Integrity Clinical Compliance Auditor... ...performing compliance reviews of medical and... ...providers who submit claims for payment. This position... ...This position is Remote in Massachusetts.... ...~ Nurse licensure (RN or LPN) with a... ...information, and healthcare billing practices...Remote workClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$140k - $160k
...advances performance, and clinical expertise that... ...The Medical Review Manager, Program Integrity... ..., altered records, billing pattern anomalies,... ...review team (RN, LPN, coder, and support... ...Analyze Medicare claims data and medical record... ...we are open to remote candidates in the following...Remote workClaimsContract workFor contractorsWork at office- ...comprehensive training curricula for clinical audit nurses and audit... ...covering IPF and IRF claim review, documentation requirements,... ...distinctions, and facility-specific billing rules. Maintain and update... ...for effective delivery in a remote environment. Training...Remote workClaimsFull timeWork at office
- ...Clinical Validation Reviewer Performs focused clinical reviews of inpatient... ...and outpatient claims to verify that coded... ...services rendered, and billed charges. Assesses... ...Registered Nurse (RN). License must be active... ...Preferred: Certified Coding Specialist (CCS), Registered...Remote workClaimsWork at office
$78k - $85k
...Nurse Reviewer - Itemized Bill Review It takes great medical minds to create... ...medical records, healthcare claims, itemized medical bills, and... ...practices. This position requires clinical review expertise as well as... ...required CEUs to maintain RN licensure. Attend training...Remote workClaimsFull timeWork from homeFlexible hours- ...something that matters. As Medical Reviewer, you'll be shaping the future... ..., fix packet defects pre‑bill, and run our ADRs/appeals processes... ...Build a 2‑gate QA (1: clinical completeness; 2: billing correctness... ...it on all surgical‑dressing claims. Create/upgrade templates...Remote workClaims
- Back Medical Claim Review Nurse | Remote | Washington | Contract Business... ...initiatives, and clinical claim validation for... ...Active unrestricted RN license preferred (LPN... ...CPT, and HCPCS coding Billing and coding experience... ...healthcare recruiting specialists Resume and interview...Remote jobClaimsContract workWork at officeImmediate startMonday to Friday
$75k - $85k
...Details Job Location: Remote - Remote Employees, VA... ...Virginiaandhasprovenexpertiseproviding independent medical reviews, records/data... ...ReviewNurse. The Claims ReviewPositionwill play... ...of care,billing, coding,and other... ...Determinetheappropriate typeof clinical reviewernecessaryto...Remote workClaims- ...Provide timely review and determination of medical claims, including prior... ...Coding Specialist (CCS) certification... ...Registered Nurse (RN),as required by... ...). ~1+ years clinical experience required... ...Medicare billing and payment irregularities... ...Remote but need to be...Remote workClaimsContract workFor contractorsWork experience placementWork at officeLocal area
- ...scalable solutions and clinical expertise help solve... ...Team Member. This is a REMOTE position within US ONLY... ...Active, unrestricted RN license (compact preferred... ...Summary The Clinical Review Specialist provides clinical... ...or outpatient hospital claims Proficiency with EMRs...Remote workClaimsPermanent employmentFull timeWork at officeImmediate startMonday to FridayShift work
$85k - $108k
...Difference: The Medical Claims Review Nurse provides... ...and claim patterns using clinical nursing knowledge and coding... ...of the Hospital Bill Review process Retrospective... ...(Preferred) Active RN clinical license... ...incentive and reimbursement; remote work and continuing education...Remote workClaimsFull timeTemporary workWork at officeFlexible hours$26 - $30 per hour
...Medical Coding Specialist Job Description... ...Location 100% remote Equipment will... ...codes to professional billing encounters based on... ...coding guidelines. Reviews and codes... ...identify coding-related claim issues, and independently... ...providers and clinical staff to clarify...Remote workClaimsHourly payPermanent employmentTemporary workWork experience placementLocal areaMonday to Friday- ...WNS, part of Capgemini, is seeking a remote RN/LPN for utilization review in the United States. The role involves assessing medical necessity, resolving escalations, and maintaining HIPAA-compliant documentation with HealthHelp policies. Requires active nursing license...Remote workWork at office
- Molina Healthcare is seeking a registered nurse with inpatient claim review experience to ensure diagnoses, procedures, revenue codes, and DRG assignments accurately reflect the documented care and billed charges. You will apply ICD-10, DRG and revenue code guidelines,...Remote jobClaims
- ...Description Job Description RN Clinical Reimbursement Specialist Join the Sweetwater Care... ...: Conduct thorough reviews of medical records, patient information, and billing data to ensure accurate reimbursement... ...accurate and complete claims for submission to payors...ClaimsFull time
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant,... ...losses due to errant billing practices. We are the... ...primarily performs medical claims audit reviews. As a... .... You will work remotely in a fast paced and dynamic... ...Active unrestricted RN license in good...Remote workClaimsFor contractorsWork at officeWork from homeHome officeShift work- ...is seeking a Senior Clinical Coding Specialist to join its Revenue Operations... ..., supporting timely billing and reimbursement... ...This position works remotely and collaborates... ...Anderson is responsible for reviewing medical records,... ...correct professional claim coding • Adhere to...Remote workClaimsFull timeApprenticeshipWork experience placementWork at officeLocal areaRelocation packageMonday to FridayFlexible hours
$76k
...are currently seeking a BPO Clinical Review Specialist to join our team in Tampa, Florida... .... Position is fully remote only in the state of Florida... ...Active Registered Nurse (RN) license required. (Not encumbered... ...for the appeal. Review claim and service appeals for...Remote workClaimsPermanent employmentTemporary workLive inWork at officeImmediate startRelocationFlexible hours$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances... ...may also handle clinical claim appeals from providers. This position... ...and prepare cases for review and appeals. Minimum Qualifications...Remote jobClaimsFull timeMonday to FridayShift work
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