Remote Medical Claims Reviewer II (RN)
your Jared
- Remote job
BlueCross BlueShield of South Carolina is seeking a Registered Nurse to perform medical reviews using clinical information and established guidelines. The role includes documenting decisions and supporting medical claims and utilization practices from a remote location in South Carolina, Georgia, North Carolina or Alabama. Responsibilities include educating staff on reviews, coding, and coverage determinations, plus participating in quality control and team education activities. #J-18808-Ljbffr your Jared
- ...BlueCross BlueShield South Carolina subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews and determine medical necessity using... ...utilization review across multiple services. The position is remote, full-time, with standard hours 8:00 AM-5:00 PM ET,...Remote jobClaimsFull time
- ...RN / Medical Reviewer / Remote Job Details Professional Discipline : Registered Nurse Specialty : Utilization Review... ...monitor medical necessity using your clinical proficiency and claims knowledge. This is a REMOTE opportunity for candidates...Remote workClaimsFull timeContract workLocal areaShift work
- Palmetto GBA is seeking an experienced RN for remote utilization review to evaluate medical claims using established criteria and guidelines. The role emphasizes timely decisions, documentation, and collaboration with internal teams. You will work from a home office and...Remote jobClaimsWork from homeHome office
- Gainwell Technologies is seeking a Medical Reviewer (Registered Nurse) to support California healthcare programs.... ...to review medical records, healthcare services, claims, and authorization requests. You will work remotely within California with flexible hours, contributing...Remote jobClaimsFlexible hours
$79.1k - $105.95k
...is responsible for performing RN duties using established guidelines... ...of stay of the patient are medically appropriate for inpatient stay... ...related to medical benefits, claims, care coordination and other... ...Management does NOT apply to RN II role within HCS) : ~ RN’s...Remote workClaimsFull timeLive inLocal areaMonday to FridayWeekend work- ...seeks an experienced Registered Nurse to perform medical review of complex claims, pre-authorization requests, appeals, and fraud... ...support accurate payment determinations. The role is remote and full-time, requiring an active RN license and at least two years of clinical...Remote jobClaimsFull time
- ...Title - Medical Coder II, Certified Shift - (Remote working after on-site training (2-4 weeks). Must be located... ...experienced coding position focused on review of documentation and coding. This... ...will ensure accurate coding and claim submission and conformity to...Remote workClaimsPermanent employmentFlexible hoursShift work
- J29, Inc. is seeking a Medical Reviewer, RN Coder for a remote, temporary assignment. The role is expected to last approximately 3-6 months and focuses on reviewing Medicare FFS claims via automated and manual processes to identify overpayments and ensure compliant, accurate...Remote jobClaimsTemporary work
- ...eligible position that is partial remote. Must be local in San Diego... ...gastroenterology. The Coder II is responsible for ensuring... ...concurrent and/or retrospective claims data reviews for physician services,... ...diagnoses, and conditions from medical records. Assists Revenue Integrity...Remote workClaimsFull timeLocal areaRelocationWeekend work
$70k - $85k
Description: Medical Reviewer, RN Location: Remote Salary: $70,000-85,000 annually, based on years of experience About J29 J29, Inc. (J29) has been supporting... ...providing processing, review, and analysis of medical claims, records, data, and audits between areas of compliance,...Remote workClaimsFor contractorsLocal area- BlueCross BlueShield of South Carolina is seeking a registered nurse to perform utilization review for medical claims in a home-office setting. The role includes evaluating complex services, preauthorizations, and appeals while ensuring accurate coding and reimbursement...ClaimsHome office
$125k - $160k
...Improvement Specialist II When you join the growing... .... **This position is remote. Candidates must be... ...providers as supported by medical record documentation to... ...Description: Concurrently reviews inpatient records to... ...& Registration: RN License Clinical Documentation...Remote workWork at officeLocal area- Summary Performs medical reviews using clinical/medical information provided by physicians/providers... ...Provides support and review of medical claims and utilization practices. Description... ...Position, You'll Need License: Active RN licensure in state hired, OR, active...ClaimsFull timeFor contractorsWork experience placementLive inWork at officeLocal areaWork from homeHome officeMonday to FridayShift work
- ...position is responsible for reviewing medical records for appropriate provider... ...and audits acute inpatient claims. Integrates medical chart coding... ...by management. Level II (in addition to Level I Accountabilities... ...may be opportunities for remote work on all jobs posted by...Remote workClaimsWork experience placement
$69.3k - $78k
...integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial... ...position requires an active RN license and a minimum of five... ...documenting findings, all in a remote work environment. This role offers...Remote jobClaims$57.51k - $85.84k
Qlarant is seeking a Nurse Specialist II to perform medical record and claims review for Medicare, Medicaid, and other claims... ...of experience (5-7 years preferred); RN licensure is required and coding certification preferred. Remote work options are available; salary...Remote jobClaims- ...Nurse Case Manager II Location: Georgia Shift: M-F 9am-5:3... ...necessary. Interfaces with Medical Directors and Physician Advisors... ...problem solving with providers, claims or service issues. Assists with... .... Current, unrestricted RN license in applicable state(s)...Remote workClaimsFull timeWork at officeShift workDay shift
- UnitedHealth Group seeks an experienced SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims. The role requires documenting determinations and maintaining screening criteria, contributing to efficient, compliant health...Remote jobClaims
- ...Telephonic Nurse Case Manager II Location: This role... .... Interfaces with Medical Directors and Physician... ...solving with providers, claims or service issues. Assists... ...Current, unrestricted RN license in applicable... .... Ability to manage, review and respond to emails/instant...Remote workClaimsFull timeWork at officeMonday to FridayDay shift
- Peraton’s SafeGuard Services seeks a Nurse Reviewer to conduct medical record reviews, applying clinical judgment to claim payments and supporting fraud investigations. Telework is available from any state. The ideal candidate will hold a US nursing license, have 5+ years...Remote jobClaims
- ...Medical Reviewer (Registered Nurse) - Remote CA It takes great medical minds to create powerful solutions that... ...medical records, healthcare services, claims, and authorization requests.... ...and unrestricted registered nurse (RN) license to practice in the state of...Remote jobClaimsFull timeHome officeMonday to FridayFlexible hours
- ...training, after which the role is remote, except for monthly office meetings... ...minute lunch. Job Description Review, analyze, and input clinic claim codes (ICD-9/ICD-10, HCPCS, CPT) based... .... Stay current with updates on medical treatments, procedures, diagnosis...Remote jobClaimsFull timeLive inWork at officeMonday to Friday
$79.1k - $105.95k
...Transplant Case Manager navigates complex medical, social, and financial barriers by coordinating... .... Serves as mentor/trainer to new RN's and other staff as needed. Acts as subject... ...questions related to medical benefits, claims, care coordination and other complex needs...Remote jobClaimsLive inLocal areaMonday to Friday- ...Optum Waste And Error Claims Investigator Optum is a global organization that delivers... ...determine the viability of the claim for further review in a production environment. Primary... ...of professional (or facility) claims vs. medical records to determine if the claim is...Remote jobClaimsContract workWork at officeLocal areaMonday to Friday
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we’re focused... ...primarily performs medical claims audit reviews. As a MR Nurse... ...Payers. You will work remotely in a fast paced and dynamic... ...Qualifications Active unrestricted RN license in good standing, is...Remote workClaimsFor contractorsWork at officeWork from homeHome officeShift work- ...Specialist Registered Nurse (RN)When you join the growing BILH... ...people's lives.This position is remote. Candidates must be local to... ...to providers as supported by medical record documentation to improve... ...limited to:Completes initial reviews of patient records within 24-4...Remote workWork experience placementWork at officeLocal area
$26.86 - $39.5 per hour
...services. Resolves billing work queue edits, reviews claim denials and makes appropriate... ...10, ICD-10 PCS and CPT/HCPCS. This is a remote position! Employees working from residences... ...skill set, and experience. Benefits: Medical, Dental and Vision coverage including coverage...Remote jobClaimsReliefRelocation packageFlexible hoursDay shift$21.28 - $29.32 per hour
...currently looking for a RCIS Crop Claims Field Adjuster I or RCIS Crop Claims Field Adjuster II or RCIS Crop Claims Specialist... ...of negligence. Complete claim reviews and audits on lower-level... ...participate on CAT team and/or provide remote assistance for the CROP Claims...Remote workClaimsHourly payFull timeTemporary workWork at officeLocal areaWork from homeVisa sponsorship- ...seeking a Follow Up Specialist II to manage timely follow-up on outstanding insurance claims and ensure accurate reimbursement... ...will analyze account activity, review EOBs, contact payers, and collaborate... ...staff to resolve issues. This remote, nationwide position requires...Remote jobClaims
- Signature Performance is seeking a Follow Up Specialist II to manage timely follow-up on insurance claims and ensure accurate reimbursement. You will analyze... ...to resolve issues. The role requires experience in medical billing or revenue cycle operations, proficiency with...Remote jobClaims
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Medical Claims Reviewer II (RN). Be the first to apply!
- medical reviewer Brooklyn, NY
- remote clinical documentation specialist Brooklyn, NY
- medical records administrator Brooklyn, NY
- health records assistant Brooklyn, NY
- clinical documentation specialist Brooklyn, NY
- medical records clerk part time Brooklyn, NY
- clinical medical assistant Brooklyn, NY
- medical records reviewer remote Brooklyn, NY
- medical record assistant Brooklyn, NY
- medical records reviewer Brooklyn, NY


