Claims Review Management Nurse (RN)

Job Description

Job Description

Claims Review Management Nurse (RN)
Location: Harrisburg, PA (Hybrid)
Schedule: Monday-Friday | 8:00 AM - 4:00 PM
Pay: $40.00-$42.00 per hour
Job Type: Full-Time | Long-Term Contract (37.5 hours/week)

Claims Review Management Nurse (RN)

We're seeking an experienced Registered Nurse (RN) with a strong background in medical claims review, coding, and Medicaid or Medicare claims processing. This is a long-term opportunity offering a consistent Monday-Friday schedule with hybrid work flexibility.

Schedule

• Monday-Friday
• 8:00 AM - 4:00 PM
• 37.5 hours per week

Pay

• $40.00-$42.00 per hour

Location

Harrisburg, PA

This position is eligible for part-time teleworking. Candidates should expect to work onsite in Harrisburg two days per week and three days working from home in home office.

Responsibilities

• Review, analyze, and process medical claims within the payment system.
• Assist with medical coding and procedure code groupings.
• Participate in annual coding updates and system enhancements.
• Evaluate current claims processing workflows and recommend process improvements.
• Support projects related to provider enrollment, medical review, and provider inquiries.
• Research medical policies and compare practices across states.
• Provide operational recommendations for claims processing decisions.
• Collaborate with management, project teams, and external stakeholders.
• Assist with policy and regulatory recommendations to improve program operations.
• Perform additional duties as assigned by management.

Qualifications

• Active Pennsylvania Registered Nurse (RN) license required.
• Minimum of five (5) years of experience in claims review, claims processing, or medical coding.
• Experience with HCPCS Level II, CPT, and/or Dental coding.
• Knowledge of Medicare and/or Pennsylvania Medical Assistance (Medicaid) coding guidelines.
• Experience using PROMISe or a comparable healthcare claims processing system.
• Strong computer skills, including Microsoft Excel, Word, and PowerPoint.
• Experience researching medical policies and participating in healthcare projects or process improvement initiatives is preferred.

PROMISe, Medicaid, Medicare, HCPCS, CPT, Medical Coding, Claims Review , Claims Processing, Medical Review, Quality Review, Case Management, Utilization Review, Prior Authorization, Policy Analysis, RN Claims Analyst, Clinical Review Nurse, Medical Review Nurse, Utilization Review Nurse, Clinical Appeals Nurse, Nurse Auditor, Nurse Consultant, Medical Management Nurse, Quality Review Nurse, Claims Processing Nurse, Coding RN, Nurse Reviewer, Clinical Documentation Specialist

Why Apply?

• Competitive hourly pay
• Hybrid work schedule
• Consistent weekday hours with no weekends

Please Contact:

Katherine Skelton