Remote Medical Review Nurse - CMS RAC Audits
Machinify, Inc.
Machinify is seeking a Medical Review Nurse (CMS RAC) in Plantation, FL. In this remote role, you will review claims audits for government clients, applying appropriate medical guidelines. A valid RN license and experience in nursing and claims review are essential. Machinify offers a comprehensive benefits package, including health insurance and a 401(k) plan. Join a team committed to reshaping healthcare through unmatched intelligence and efficiency. #J-18808-Ljbffr
$81k - $90k
...Santa Barbara Cottage Hospital is looking for a Medical Review Nurse to perform medical claims audits primarily for government clients. The role requires an... ...collaborating with the audit team. This position offers a remote work environment, with a competitive salary range of...Remote workCmsMedical$81k - $90k
...The Rawlings Group seeks a Medical Review Nurse, focusing on auditing medical claims for government clients. The role requires an active RN license and... ...with teams to improve processes. This position allows for remote work and involves working in a dynamic environment. The...Remote workCmsMedical$80k - $90k
...Responsibilities*** Performs clinical reviews on medical records to maintain subject... ...reviews on medical review audit work completed by the medical... ...and an understanding CMS, Medicaid and/or Commercial insurance... ...to work independently in remote setting with minimum supervision...Remote workCmsMedicalFlexible hours$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX Agency: Mindlance Health... ...contact and will include 80% travel. Remote role. Will require a driver’s license... ...partner with top-tier hospitals and medical institutions nationwide, helping you...Remote workCmsMedicalHourly payFull timeContract workImmediate startShift work3 days per week- ...Case Management/Utilization Review Pre-Cert Review* Prior Authorizations... ...Stay Reviews Determine Medical Necessity per Evidence-Based... ...Ambulatory Regulatory CMS: Centers for Medicare and... ...Goals Additional Skills remote UR work CA and Medi-Cal experience...Remote workCmsMedical
- ...Position Summary Concurrent Review Nurse is responsible for performing... ...management activities to ensure medical services are delivered... ...procedures. Ensure compliance with CMS guidelines, accreditation... ...organizational skills. Work Environment Remote Equal Opportunity Employer...Remote workCmsMedicalApprenticeshipLocal area
- ...transforming commercial insurance - we want to meet you. Medical Review Nurse Carbon Stop Loss Solutions is a leading managing general... ...management skills. Ability to work independently in a remote setting. Ability to work with multiple offices and underwriters...Remote workCmsMedical
- ...Administrative Nurse At Reliant Management... ...Conduct regular audits of nursing documentation and medical charts for accuracy... ...regulatory compliance Review resident care records... ...regulatory updates (CDPH, CMS) to inform audit... ...and with remote teams Riverside PostAcute...Remote workCmsMedical
- ...Job Title: Medical Claim Review Nurse Location: 100% Remote Duration: 3 to 6 months ( Opportunity for ext. / based off performance/evaluation... ...HCPCS, Diagnosis and Procedure codes) Chart Audit for coding and medical necessity CMS and State specific knowledge (ability to...Remote workCmsMedicalWork at officeMonday to FridayShift work
$85k
...Job Description DRG Coding Reviewer - Auditor (Remote) Compensation and Benefits Salary... ...experience Strong knowledge of ICD-10, CMS guidelines, and coding compliance... ...opportunities for qualified candidates across medical professions. We deliver timely results...Remote workCmsMedicalFull timeShift work$50.68 per hour
...Overview The Utilization Review RN participates as a... ...multidisciplinary team to support medical necessity reviews,... ...will be primarily remote but may require onsite... ...requirements, including CMS and Joint Commission Standards... ...Bachelor of Science in Nursing (BSN). Three years of...Remote workCmsMedicalHourly payLive inRelocationFlexible hoursShift workWeekend workDay shiftAfternoon shift$85k - $90k
...parental leave, and more. The Nurse Coder DRG Auditor’s primary responsibility is to review medical records and associated claim information... ...and Medicaid Services (CMS), commercial payers, InterQual,... ...CCS, CPC, CIC Coding validation/auditing experience Well-developed...Remote workCmsMedicalWork at office$66.4k - $109.53k
...materials as needed. Performs audits on schedule or as assigned based... ..., examples of relevant medical records, resource materials, etc. Works with Manager to review findings from external audits... ...Environment and Physical Requirements: Remote work from home. Supervisory...Remote workCmsMedicalFor contractorsWork from homeShift work- ...Description The utilization review (UR) nurse serves to maximize the... ...regular utilization reviews and audits, the UR nurse ensures that patients... ...knowledge of patient care, medical treatments and hospital... ...with ensuring compliance with CMS Conditions of Participation for...CmsMedicalFull timeWork at officeMonday to FridayShift work
- ...Director of HIM in preparing claim audits, reviewing and recommending coding,... ...assigned. Location & Status Remote USA; work from home office. Full... ...information and access to medical documentation. Audit all aspects... ...and apply guidelines, CMS/Payer specific guidelines, coding...Remote workCmsMedicalFull timeWork at officeWork from homeHome office
- ...LOCATION Remote – This is a home based, virtual... ...and post-payment audits of DRG coding and... ...inpatient medical records and generating... ...recoverable claims by reviewing medical records... ...determinations, and CMS and other... ...Bachelor's degree in nursing with an active license...Remote workCmsMedicalLive inWork from homeMonday to Friday
$93.8k - $106k
...Billing Compliance Reviewer Reporting to the Director... ...and executes risk-based audits, analyzes documentation and coding for medical necessity and regulatory... ...selection in alignment with CMS, OIG, and other... ...revenue integrity, pharmacy, nursing, research billing, and practice...Remote workCmsMedical- ...Operations Job Title: Quality Review and Audit Analyst Duties: The Risk... ...Review Analyst in IFP brings medical coding and Hierarchical... ...internal program processes ensuring CMS/HHS compliant programs,... ...Hours 9am - 5:30pm EST 100% Remote Financials: Currency USD...Remote workCmsMedicalMonday to FridayShift work
$93.4k - $116.8k
...including quality of care reviews, incident investigation... ...and your loved ones, Medical, Dental, Vision, Life... ...programs are aligned with CMS Triple Aim framework:... ...and studies. Conducts audits of patient/member case... ...professional nurse preferably in New York...Remote workCmsMedicalWork experience placementFlexible hours- ...better care. The HSCRC Coding Reviewer will be a subject matter... ...abstraction, clinical coding, auditing, and variables impacting HSCRC... ...methodologies that are based in medical record documentation.... ...Physical Demands This is an office/remote position. While performing the...Remote workCmsMedicalContract workWork at office
$16.9 - $23.42 per hour
...Bill Review Analyst I - Temp The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote, temporary position. Essential functions... ...4/DWC-9/DWC-10 and CMS 1500 form types...Remote workCmsMedicalHourly payFull timeTemporary workWork at officeFlexible hours$78.5k - $90k
...Performant Recovery, Inc. is hiring a Medical Review Nurse for remote work focusing on auditing medical claims for Home Health services. This role involves document audits, collaboration with audit teams, and staying updated on regulatory issues. The ideal candidate will...Remote workMedical$68k - $88k
...Medical Review Auditor (Fraud Waste and Abuse) Join to apply... ...Reviewer, you will be auditing medical records to... ...licenses: Licensed Practical Nurse (LPN) Registered Nurse... ...guidelines (including CMS NCCI). Healthcare... ...Premium Insurance Auditor - Remote Remote: Full Time...Remote workCmsMedicalHourly payFull timeContract workPart timeWork experience placementImmediate startWork from home$68.57k - $104.84k
...Clinical Review QC Auditor CERIS in Fort Worth, TX... ...clinical/coding) reviews of medical records and/or other... ...rules. This is a remote position. Essential... ...DRGs assigned Conduct audits to ensure accurate reimbursement... ...of Medicare, CMS guidelines and ICD-10 coding...Remote workCmsMedicalMinimum wageFull timeWork at officeLocal areaFlexible hours$58.4k - $97.4k
Job Summary The Quality Review & Audit Senior Analyst ("Analyst") exhibits expertise in evaluating complex medical documentation for diagnosis code accuracy and compliance in support... ...medical diagnosis coding. Familiarity with CMS regulations for Risk Adjustment programs...Remote jobCmsMedicalWork experience placementLocal areaWork from home- ...Inpatient Auditor (Coding Quality Review / Educator) WFH (OK, TX, AR,... ...MO) Department HIM Coders Remote Eligibility Candidates must... ...within the body of the medical record to support code assignments... ...Three years inpatient coding auditing experience strongly preferred...Remote workCmsMedicalFull timeWork at officeWork from home
- ...Opportunity As a Clinical Bill Review Analyst, you’ll review... ...You’ll Do Here Review medical bills to identify... ...the Team 3+ years of auditing, claims, review and/or... ...written. Knowledge of CMS guidelines. A plus if... ...ll Work This is a fully remote position, and we’ll provide...Remote workCmsMedicalImmediate startFlexible hours
$30 - $34 per hour
...Complex Medicare Claims Review Complex Medicare claims/prior authorization... ...requests require the review of medical record documentation to determine... ...are required to use Registered Nurses ("RNs"). Clinical decisions will be based on CMS policies/procedures defined in the...Remote workCmsMedicalHourly payContract work$100k - $166.6k
...Position Summary Quality Review & Senior Audit Advisor provides... ...ensure alignment with CMS, NCQA, and state regulatory... ...integrity, including medication therapy management,... ...clinical, pharmacy, nursing, or healthcare‑... ...cost drivers preferred. Remote Work Requirements Internet...Remote workCmsMedicalWork at officeLocal area- ...Nurse Auditor Have you ever looked a medical bill and immediately noticed something was wrong? Were you itching... ...team and maximize client savings by reviewing medical bills from a nurse perspective... ...billing statements, and will: Audit medical and billing records to...Remote jobMedicalImmediate start
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