Medical Review Nurse - CMS/RAC Auditor, Government Audits (Fully Remote)
Machinify
- Remote job
Join a team of experienced medical auditors and coders performing audits for government payers. Work remotely in a fast-paced, dynamic, multi-location team. Responsibilities: Audit claims for medical appropriateness and document findings. Draft appeal letters and collaborate to improve policies and workflows. Qualifications: Active RN license and five years of nursing experience required. ICD-10, CPT/HCPCS, and DRG billing experience required; RAC certification preferred. Machinify Machinify is a healthcare intelligence company providing AI-powered payment solutions for health plans. It serves over 85 health plans and more than 270 million lives, with a culture focused on innovation and reducing healthcare costs. #J-18808-Ljbffr Machinify
- Machinify is seeking a Medical Review Nurse to perform CMS/RAC audits for government payers. This remote role involves working with a multi-location team to review claims, document findings, and support appeals. RAC certification is preferred and candidates may work toward...Remote jobCmsMedical
- ...retrospective and prepayment audits on skilled nursing facility (SNF) claims for government and commercial payers. Work remotely in a fast-paced, dynamic... ...: Audit claims for medically appropriate services in SNF... ...settings, applying medical review guidelines and policies....Remote jobMedicalFor contractorsWork at office
- Machinify is seeking a Medical Review Nurse II - Commercial DME to perform retrospective/prepayment audits on government and commercial payer claims. This remote role requires handling desk audits, documentation of findings, and supporting appeals in a fast-paced environment...Remote jobMedical
- We are hiring nurse auditors who can commit to... ...opinions on medical necessity, coding... ...product, the Claims Review (CR) report,... ...so you are fully independent before... ...validation Audit assigned draft... ...technical issues in a remote work... ...including the CMS-HCC risk adjustment...Remote jobCmsMedicalHourly payContract workFor contractorsHome officeOverseasMonday to FridayFlexible hoursShift workNight shiftWeekend workAfternoon shiftWeekday work
$38 per hour
Remote Inpatient/Outpatient Coding Auditor VISN 7 Health Information Management Services... ...Supporting VISN 7 medical facilities Fully remote coding and auditing services... ...will independently review inpatient and outpatient... ...services to the federal government and commercial...Remote jobCmsMedicalHourly payFull timeContract workPart timeLocal areaShift work- Machinify is seeking a Medical Review Nurse II - Commercial DME to audit medical claims for appropriate services in inpatient and outpatient settings. This remote role supports government and commercial payers in a fast-paced, cross-functional team. You will document findings...Remote jobMedical
- ...Nurse Auditor Full-time Company Description Healthcare... ...on post payment claims audits and performs related... ...Proven knowledge of medical and surgical procedures... ...Demonstrated competency in claim review and experience in using... ...and claims forms (UB, CMS, and HCFA). Normally...Remote workCmsMedicalFull timeWork at office
- ...Nurse Auditor Remote We are seeking a detail-oriented Registered Nurse (RN)... ...efforts with a focus on charge audit and billing validation. In this role, you will review medical records and itemized bills to... ...all billing aligns with CMS and payer requirements, national...Remote workCmsMedicalTemporary work
- SelectHealth - Murray offers a fully remote, part-time role reviewing medical records to support HEDIS, CMS, and STARS measures. You will collaborate with the HEDIS team, access a proprietary abstraction tool, and perform offsite reviews for documentation accuracy. The...Remote jobCmsMedicalPart time
- ...of Outpatient Coding Auditor, you will be responsible for quality reviews and audits and coordinating with... ...experience in professional medical coding/reimbursement... ...costs for federal government agencies, payers, and... ...Signature believes in fully developing each one of...Remote workCmsMedicalTemporary workWork experience placementWork at office
- Emory Healthcare is seeking a remote medical coder/auditor to ensure accurate coding... ...services. You will review records, verify CPT/ICD-10/... ...teams. The role emphasizes audits, education, and ensuring appropriate... ...maintaining HIPAA and CMS compliance. Candidates should...Remote jobCmsMedical
- ...Healthcare is seeking a remote professional coder to ensure accurate medical coding for professional... ...documentation. You will review records, collaborate with... ...compliance teams, conduct audits, educate staff, and... ...while maintaining HIPAA and CMS guidelines. #J-18808-...Remote jobCmsMedical
- ...seeking a Lead Associate, Itemized Bill Review Quality Auditor to perform reviews of medical records, healthcare claims,... .... You will lead quality assurance audits and oversee itemized bill review activities... ...of hospital charging practices, CMS reimbursement, NCCI edits, and...Remote jobCmsMedical
$59.3k - $80.9k
...our caring community The Medical Coding Auditor reviews medical claims submitted... ...and CPT coding guidelines, government regulation and protocols... ...impact WORK STYLE: Remote, work at home. While this... ...experience ~ Outpatient facility auditing experience ~ Experience...Remote workCmsMedicalBi-weekly payFull timeContract workTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday- ...The Clinical RN Chart Reviewer will perform clinical reviews of medical records and other documentation... ...will include: Audits and analyzes neonatal intensive... ...: ~ Registered Nurse required. ~2+ years with... ...clinic determinations, and CMS and other regulatory compliance...Remote workCmsMedicalTemporary workCasual workWork at office
- ...Compliance - Education And Audits Work Shift: Day... ...Montefiore Medical Center revenue and... ...Participates in external government audits, including:... ...Medicaid Services (CMS) National Government... ...Audit Contractor (RAC) Zone Program Integrity... ...and regulations. * Review of updated forms...CmsMedicalFor contractorsWork at officeLocal areaShift work
- ...Quality Control/Clinical Auditor. The Diagnostic... ...validation (clinical/coding) reviews of medical records and/or other... ...rules. This is a remote position. ESSENTIAL FUNCTIONS... ...assigned Conduct audits to ensure accurate... ...understanding of Medicare, CMS guidelines and ICD-10...Remote workCmsMedicalMinimum wageFull timeWork at officeLocal areaFlexible hours
- ...healthcare, finance, government, and... ...This is a remote position. RN Clinical Auditor - Behavioral... ...Health Location: Fully Remote, with... ...Registered Nurse Clinical... ...to support medical record reviews and billing compliance audits for the Indiana... ...with IHCP, CMS, AMA, and behavioral...Remote workCmsMedicalContract work
$68k - $88k
Medical Review Auditor (Fraud Waste and Abuse) Join to apply for the... ...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- ...seeking a qualified Clinical Reviewer to provide expert review of medical claims and post-service appeals... ...perspective. You will audit complex Medicare claims, apply CMS guidelines, and collaborate with... ...SCAN’s mission and goals. This remote role offers a comprehensive benefits...Remote jobCmsMedical
- ...Have you ever looked a medical bill and immediately noticed something... ...Solutions is looking for a Nurse Auditor who wants to make their mark... ...and maximize client savings by reviewing medical bills from a nurse... ...will: Responsibilities Audit medical and billing records to...Remote workMedicalCasual workWork at officeImmediate startFlexible hours
$55k - $75k
...specializing in assisting government and commercial... ...solutions, audit, investigation, and medical review. At IntegrityM,... ..., the Medicaid Auditor will be... ...quality cases are fully prepared. Maintains... ...oversight programs. (CMS, HRSA, OIG, DOE,... ...checks. For remote work, required to...Remote jobCmsMedicalFull timeContract workTemporary workFor contractorsWork at officeLocal areaFlexible hours$38.61 - $55.86 per hour
...Medicare Advantage, fully integrated care... ...for the most medically and socially... ...Services (DHCS) auditing team... ...and subsequent reviews of Primary Care... ...accordance with CMS and DHCS and contractual... ...Qualifications Registered Nurse License (RN)... ...Work Mode: Remote/Field (This...Remote workCmsMedicalHourly payContract workFor contractorsLocal areaFlexible hours$90k - $105k
...brings together a fully configurable and... ...one of our other Medical Review Nurse roles, which may... ...) medical claims audit reviews. As a MR... ...experienced medical auditors performing... ...audits on claims for Government and Commercial Payers... .... You will work remotely in a fast-paced...Remote workMedicalFull timeFor contractorsWork at office$35.22 - $53.29 per hour
Job Description To review medical records retrieved from provider... ...Set) annual audits. Interprets relevant clinical... ...with HEDIS, CMS, and STARS performance... ...required as well for fully remote position. Job Essentials... ...Bachelor's Degree in Nursing (BSN) from an accredited...Remote workCmsMedicalHourly payWork experience placementReliefWork at officeLocal areaFlexible hours$60.1k - $85.8k
It takes great medical minds to create powerful solutions... ..., Itemized Bill Review Quality Auditor to perform reviews of... ...conducting quality assurance audits and oversight of... ...billing requirements, CMS reimbursement methodologies... ...Management, Nursing, Healthcare Administration...Remote jobCmsMedicalFull timeWork from homeFlexible hours$70k - $80k
...Exception only) It takes great medical minds to create powerful... ...for aSenior Coding Auditor, Itemized Bill Reviewer who is responsible for performing... ...inpatient hospital bill auditing, outpatient facility... ...expect in this role 100% Remote Position Up to 10% travel...Remote jobCmsMedicalFull timeContract workFlexible hours- Machinify is seeking a Medical Review Nurse II - Commercial DME to perform retrospective and prepayment medical claims audits for Government and Commercial payers. This remote U.S. role joins a multi-location team of expert auditors and coders, delivering high-quality reviews...Remote jobMedical
- ExamWorks is seeking a Utilization Review Nurse Auditor to perform quality utilization reviews and authorize medically necessary care. The role is fully remote with standard EST hours, requiring an active nursing license and coding certification. You will work with providers...Remote jobMedical
- ...brings together a fully configurable and... ...healthcare costs. The Medical Review Nurse II - Commercial... ...medical claims audit reviews. As a MR... ...medical auditors and coders performing... ...audits on claims for Government and Commercial Payers... .... You will work remotely in a fast paced...Remote workMedicalFor contractorsWork at office
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