Remote Clinical Claim Review RN — Coding & QA Expert
Registered Nurse
- Remote job
Optum is seeking a Clinical Claim Review Nurse to perform claim reviews and ensure compliance in a telecommute role. You will verify coding accuracy and support health outcomes by connecting people with necessary resources. This role requires an Associate's degree, active RN license, and clinical experience. You’ll enjoy comprehensive benefits, including health plans, paid time off, and a flexible work environment. #J-18808-Ljbffr Registered Nurse
- ...University of Minnesota School of Nursing is seeking a Clinical Claim Review Nurse who will perform claim reviews to verify coding and charges. You will work independently and... ...must hold an associate's degree and an active RN license, with a minimum of 2 years of clinical...Remote jobClaims
- Texas Health Institute is hiring a Clinical Claim Review Nurse to perform claim reviews, ensuring correct coding and charges. Telecommute from anywhere within the U.S. while... ...possesses an Associate's degree, an active RN license, and at least 2 years of clinical experience...Remote jobClaims
- Stryker Corporation is seeking a Clinical Claim Review Nurse to perform detailed reviews of claims against medical records. The position offers... ...Candidates should possess an Associate's degree and an active RN license. Responsibilities include ensuring compliance with guidelines...Remote jobClaims
- Optum is looking for a Clinical Claim Review Nurse to perform claim reviews and ensure compliance with... ...state and federal policies. This fully remote position allows you to contribute to... ...possess an Associate's degree, an active RN license, and at least 2 years of...Remote jobClaims
- UnitedHealth Group is seeking a Clinical Review Clinician in Plymouth, Minnesota. This role involves... ...forensic reviews of hospital bills and claims while ensuring compliance with billing... ...have an Associate's degree, an active RN or LPN license, and at least 2 years of...Remote jobClaims
$28.94 - $51.83 per hour
...Clinical Review Clinician Optum is a global organization that... ...as a subject matter expert for itemized bill reviews... ...understanding of the claim review process including... ...Active and unrestricted RN license OR LPN in the... ...Qualifications: Auditing and coding certifications...Remote workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area$80k - $90k
...Responsibilities*** Performs clinical reviews on medical records... ..., analyzes claims data, applies... ...Become subject matter expert for assigned... ...ICD-9/ICD-10/MS-DRG coding may be necessary.*... ...independently in remote setting with minimum... ...Active unrestricted RN license #J-18808-...Remote workClaimsFlexible hours- Optum is hiring a Clinical DRG RN auditor to verify DRG coding accuracy and reimbursements while telecommuting from anywhere in the U.S. In this role, you... ...use your ICD-10 coding expertise to audit inpatient claims, identify overpayments, and support your findings with...Remote jobClaims
- ...for a qualified applicant to perform medical reviews and support medical claims processing. The role involves reviewing... ...documenting decisions based on established clinical guidelines. Applicants must hold an active RN license and have at least two years of clinical...Remote workClaimsFull time
$70k - $80k
...analytics and solutions company is seeking a Clinical Validation Auditor to ensure accuracy in medical claims coding. This fully remote position requires a Registered Nurse with... ...care experience. Responsibilities include reviewing medical records, documenting findings, and...Remote jobClaims- ...company located in New York is looking for a Clinical Auditor to perform clinical reviews and audits on medical records, ensuring compliance... ...guidelines. This role requires an active RN license and the ability to analyze claims data and regulations effectively. The...Remote jobClaims
$28.94 - $51.83 per hour
Crains Cleveland is seeking a Clinical Review Clinician to perform Forensic Reviews on hospital bills, assisting with claims resolution and departmental goals. The role requires strong clinical knowledge and the ability to analyze charge details comprehensively. Benefits...ClaimsHourly pay$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant... ...performs medical claims audit reviews. As... .... You will work remotely in a fast paced... ...; assist with QA functions and... ..., CPT-4 or HCPCS coding. Knowledge of insurance... ...unrestricted RN license in good standing...Remote workClaimsFor contractorsWork at officeWork from homeHome officeShift work- ...hybrid, onsite or remote. While the majority... ...Customer Service, Claims Processors, and... ...activities. Provide clinical and operational analysis... ...Conduct clinical review of complaints... ...and subject matter experts. Practice... ...of CPT-4 and ICD coding Knowledge of URAC...Remote workClaimsFull timeWork experience placementWork at office1 day per week
- Stryker Corporation is looking for a Clinical Claims Review RN to perform reviews of inpatient hospital claims. This role supports a high-volume environment and allows for telecommuting from anywhere in the U.S. The ideal candidate must have an RN license, a minimum of...Remote jobClaims
$50 - $53 per hour
...Job Title: Clinical Review RN (IDR/Appeals) Experience: Open to various clinical backgrounds... ...State RN license*** Location: Remote (can sit anywhere in the US as long as... ...RNs as the project expands. 4. Claims assessment and adjudication. 5....Remote workClaimsLocal areaImmediate startFlexible hours$28.94 - $51.83 per hour
Crains Cleveland is seeking a Clinical Claims Review RN to perform administrative reviews of short-stay inpatient hospital claims. This role supports a production-driven environment and allows telecommuting from anywhere in the U.S. The ideal candidate must have an associate...Remote jobClaimsHourly pay- Optum, part of the UnitedHealth Group, is looking for a Clinical Claims Review RN to conduct administrative reviews of short stay inpatient hospital claims. This position is open to telecommuting from anywhere in the U.S. and is situated in a high-volume, production-driven...Remote jobClaims
- Optum, part of the UnitedHealth Group, is looking for a Clinical Claims Review RN to conduct administrative reviews of inpatient hospital claims. Ideal candidates will have a strong background in clinical documentation and RN qualifications. The role emphasizes telecommuting...Remote jobClaims
- ...for authorization and reimbursement. You will review claims, ensure compliance with regulations, and... ...hearings. The ideal candidate has 2+ years of clinical experience, with a strong background in utilization review and coding. We offer a competitive compensation package...Remote jobClaims
$29.05 - $67.97 per hour
...Healthcare in Bellevue, WA is looking for a clinical reviewer with at least 2 years of nursing experience.... ...records and determining the medical necessity of claims. Candidates should have an active RN license, knowledge of coding, and strong analytical skills. The position...Remote jobClaimsHourly pay$29.05 - $67.97 per hour
Molina Healthcare is seeking a Clinical Nurse Reviewer in Albany, NY, responsible for reviewing medical documentation... ...medical reviews of appeals and validating claims for coding compliance. Candidates must hold an active RN license and have at least 2 years of clinical...Remote jobClaimsHourly pay$29.05 - $67.97 per hour
...seeking a qualified Registered Nurse with clinical experience to perform utilization reviews and ensure medical necessity of claims. The role involves reviewing medical documentation... ...for authorizations, and validating claims coding. The ideal candidate must have at least two...Remote jobClaimsHourly pay$36 - $48 per hour
Santa Barbara Cottage Hospital is seeking a Medical Claims Clinical Review Nurse for a remote position. This role involves conducting clinical reviews of... ...compliance with regulations. The ideal candidate will have an RN license in California and a minimum of three years of...Remote jobClaimsHourly pay- Stryker Corporation is seeking a Clinical Review Clinician to serve as a subject matter expert for itemized bill reviews. This role involves analyzing hospital bills, conducting forensic reviews, and maintaining compliance with HIPAA standards while working independently...Remote jobHourly pay
- ...for the Future is seeking a DRG Appeals Review Nurse to analyze and appeal denied MS-... ...have a Registered Nurse License, relevant coding certifications, and extensive clinical experience. Key responsibilities include reviewing claims for appeal potential, writing detailed...Remote workClaimsWork from home
$29.05 - $67.97 per hour
...Antonio, Texas, to join their team for clinical review responsibilities involving medical necessity and claims processing. This role requires at... .... Candidates must hold an active RN license and demonstrate proficiency in billing and coding standards. The position offers a...Remote jobClaimsHourly pay- MedPOINT Management is seeking a Medical Claims Clinical Review Nurse to ensure the accuracy and quality of medical claims from a remote location. The ideal candidate holds a valid RN license in California and has at least 3 years of nursing experience. Responsibilities...Remote jobClaims
$29.05 - $67.97 per hour
...clinician for a role focused on medical claims review in Albuquerque, New Mexico. The... ...demands at least 2 years of clinical nursing experience and an active RN license. Responsibilities include... ...skills, along with a deep understanding of coding practices. #J-18808-Ljbffr...ClaimsHourly pay- Molina Healthcare is seeking a clinical professional in Miami to perform utilization reviews and ensure proper coding for reimbursement. This role... ...will evaluate medical claims and facilitate appeals, contributing... ...compliance. An active RN license is essential, along...Remote jobClaims
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