Remote RN Medical Reviewer II - Home Health Claims
Palmetto GBA
BlueCross BlueShield of South Carolina is seeking an RN Medical Reviewer II for a remote, work-at-home role in South Carolina. You will review home health and hospice documentation to ensure it meets program requirements, including face-to-face encounters and plans of care. This role suits nurses who thrive in high-intensity settings and value a supportive, work-from-home environment. The position requires an Associate Degree in Nursing (or nursing school graduate) and at least two years of #J-18808-Ljbffr
- ...BlueShield of South Carolina is seeking a Remote RN Medical Reviewer II to perform medical reviews using... ...established guidelines. You will review home health and hospice documentation, determine medical necessity, and support claims and utilization practices in a work-from...Remote workWork from homeClaims
- ...BlueCross BlueShield of South Carolina is seeking a RN Medical Reviewer II for a full-time remote position based in Alabama. The role involves reviewing medical claims, determining medical necessity, and ensuring timely processing in line with guidelines. The ideal candidate...Remote workClaimsFull time
- ## RN Medical Reviewer IIApply: Remote: ****@*****.*** South Carolina: Full time: Posted Today: End Date: November 7,... ...Provides support and review of medical claims and utilization practices.# **... ...team! In this role, you will review home health and hospice documentation submitted...Remote workWork from homeClaimsFull timeFor contractorsWork experience placementWork at officeLocal areaHome officeMonday to Friday
- ...Summary Performs medical reviews using clinical/... ...review of medical claims and utilization... ...This is a full-time remote (40-hours/week)... ...regarding protected health information.... ...Certificate: Active RN licensure in state... ...Work exposure to home health hospice case...Remote workWork from homeClaimsFull timeFor contractorsWork experience placementWork at officeLocal areaMonday to FridayShift work
- ...seeking a registered nurse with clinical experience to perform medical claim reviews and determine medical necessity for coverage and... ...established protocols and guidelines. The position is full-time and remote across South Carolina, Georgia, North Carolina, or Alabama,...Remote workClaimsFull time
- ...Coder IIThe Coder II reviews outpatient records... ...patient surgical medical records (hospital... ...accurate and timely claim submission and resolution... ...Health Information Administrator... ...Pensacola, FL, 32503, US (Remote)Job Schedule Full... ...Remote (work from home)FTE 1.0 FT...Remote workWork from homeClaimsLocal areaShift work
- ...The Coder II reviews outpatient records and accurately... ...patient surgical medical records (hospital... ...and timely claim submission and resolution... ...Registered Health Information Administrator... ..., FL, 32503, US (Remote) Job Schedule... ...Remote (work from home) FTE 1.0 FT...Remote workWork from homeClaimsFull timeLocal areaShift work
- ...Qlarant is seeking a Nurse Specialist II for a full-time remote role in the United States. The position focuses on medical record and claims review for Medicare, Medicaid, and other payers to ensure guidelines are followed and to detect overpayment, fraud, waste, and abuse...Remote workClaimsFull time
- ...Broadway Ventures is seeking a dedicated Registered Nurse (RN) to join our Medical Review team in a remote role. You will conduct pre- and post-payment medical reviews to ensure criteria compliance, assess medical necessity and reimbursement eligibility, and document decisions...Remote workClaims
- ...Broadway Ventures is seeking a Medical Reviewer for a remote role handling various claims (Radiology, Ambulance, Physical Therapy, Surgical). You will apply clinical... ...clearly. Minimum requirements include an active RN license in the U.S., an Associate’s degree, and 2+...Remote workClaims
- ...Review claims files to detect potentially fraudulent billing practices. Use medical terminology and coding to assess payment appropriateness. Write investigative summary reports... ...expert testimony. Requirements: Active RN license and 2+ years Medicaid experience. ICD...Remote workClaims
- The Inpatient Coder II is responsible for assigning... ...documentation in the medical record and utilization... ...coders. Responsibilities Remote States: Candidates... ...intermediate coding edits and claim edits. Completes... ...Required Associate's Degree - Health Information Management...Remote workClaimsFull timeWork experience placement
- ...Performing medical reviews for claims and utilization practices, the full-time RN Medical Reviewer - South Carolina will evaluate clinical information, document decisions... ..., and provide support for medical claims in a remote work environment. Key responsibilities Conduct...Remote workClaimsFull timeWork at office
- ...experienced Registered Nurse to perform medical review of complex claims, pre-authorization requests, appeals, and... ...accurate payment determinations. We offer a remote, full-time position with competitive pay and benefits. Active RN licensure in the state hired is required,...Remote workClaimsFull time
- ...Broadway Ventures is seeking a Medical Reviewer to evaluate radiology, ambulance, physical therapy, and surgical claims using established criteria and clinical guidelines. This remote role requires an active RN license in the U.S. and an associate degree in nursing....Remote workClaims
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At... ...performs medical claims audit reviews. As... ...Payers. You will work remotely in a fast paced... ...unrestricted RN license in good standing... ...' experience in health care claims that... ...Internet at your home office location...Remote workWork from homeClaimsFor contractorsWork at officeHome officeShift work$26 - $30 per hour
...Medical Coder IIMeduit is a national leader in healthcare... ...Coding Specialist II is responsible for correctly... ...coding healthcare claims and analyzing denials to... ...Medical Coder II Location: Remote Schedule: 8am – 5pm in... ...claim denials within health plan requirements and document...Remote workClaimsHourly pay- ...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
- ...) Vice President, Clinical Operations - Behavioral Health UM Medicare Compliance Advisory Project Manager II Manager, Quality Improvement, HEDIS Audit Vice President... ...& Security Enterprise Engagement Officer Director, Claims Business Implementation Manager, Payment Integrity...Remote jobClaims
- ...Clinical Auditor (RN/Medical Coder) | 5 Years of Experience | Remote | Contract Walker... ...complex healthcare claims, validate medical coding... ...CPT, HCPCS Level II, ICD-10-CM, and... ...record documentation review. ~ Experience... ...Have Behavioral health coding and auditing...Remote workClaimsWeekly payContract workImmediate startMonday to Friday
- ...Medical Records Coder II (20660517) job at CalOpps. San Francisco,... ...Description San Mateo County Health is seeking... ...facility in San Mateo with remote options. The ideal... ...tracking and submitting claims related to substance... ...0-CM/CPT procedures. Review narrative records of...Remote workClaimsWork at office
$31.31 - $36.71 per hour
...The Certified Coder II is crucial to the... ...issues that impact claim quality and reimbursement... ...quality assurance reviews, and quarterly... ...documentation support and medical necessity, applying... .... When remote work is approved, the... ...Bachelor’s degree in health care or related...Remote workClaimsApprenticeshipInternshipWork at officeShift work$5,000 per month
...Medical Coder II Coding Full Time AM Shift 8 am to 5pm Sign-On Bonus: $5,000 Remote Position, Must reside in South Carolina... ...-on Bonus Lexington Health is a comprehensive network... ...Essential Functions Reviews and interprets... ...assisting with coding claim edits and reviewing...Remote workClaimsFull timeTemporary workRelocation packageFlexible hoursShift work- ...members to achieve their best health. For over 90 years, we... ...for performing RN duties using established... ...stay of the patient are medically appropriate for inpatient... ...related to medical benefits, claims, care coordination and... ...Management does NOT apply to RN II role within HCS) :RN's...Remote jobClaimsLocal areaMonday to FridayWeekend work
$79.1k - $105.95k
...members to achieve their best health. For over 90 years , we... ...for performing RN duties using established... ...stay of the patient are medically appropriate for inpatient... ...related to medical benefits, claims, care coordination and... ...does NOT apply to RN II role within HCS) :...Remote workClaimsLive inLocal areaMonday to FridayWeekend work- ...Mitigation-Appeal Specialist II RN serves in a key role of... ...following: Performs reviews of clinical information... ...appeal with corrected claims and denial resolution... ...the opportunity to work remotely after 90 days when able... ...information in the medical record, applicable payer...Remote workClaimsFull time
- ...position is responsible for reviewing medical records for... ...audits acute inpatient claims. Integrates medical chart... ...management. Level II (in addition to Level... ...bachelor's degree in health information management... ...: The opportunity for remote work may be possible for...Remote workClaimsWork experience placement
$67.6k
...partner in innovation. Medical Review Nurse (Temporary Contract, Remote) Compensation rate: $... ...are seeking a dedicated RN to conduct medical reviews... ...Remote U.S. (Work from home) Requirements for Remote... ...dialysis, managed care, home health, rehabilitation, and/or...Remote workWork from homeClaimsContract workTemporary workFor contractorsWork at officeHome officeMonday to Friday- ...RAS Companies, operating Precision Bill Review, LLC, seeks a Medical Bill Reviewer to ensure accurate and timely review of workers’ compensation medical bills. This full-time role combines work-from-home responsibilities with occasional office visits in the Sioux Falls...Remote workWork from homeClaimsFull timeWork at office
$42.77k - $61.55k
...Pay Plan Title: Claims Specialist II Working Title:... ...Office Location: Remote within North Carolina... ...Trillium Health Resources is a Tailored... ...and work-from-home options for most... ...for pre-payment review and post payment... ...claim attachments/medical documentation necessary...Remote workWork from homeClaimsFull timeWork at officeLocal areaImmediate startFlexible hours
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