Clinical Reviewer
Virtual Vocations Inc
Performing clinical claim reviews, the part-time Massachusetts Licensed Clinical Review RN will verify coding accuracy and charge correctness, ensuring compliance with state and federal guidelines while working remotely. Key responsibilities: Conduct clinical reviews of claims against medical records to assess support for claims Maintain productivity and accuracy standards while documenting findings and adhering to compliance policies Assist in resolving claims to support negotiations and the appeals process as needed Required qualifications: Associate's degree Active and unrestricted RN license in the state of residence 2+ years of clinical experience in an acute care setting 1+ years of experience in Utilization Management, claim review, or medical record review Intermediate proficiency in Microsoft Office applications
Vacancy posted 2 days ago
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