Registered Nurse (Claims & Appeals Review)
Compunnel Inc.
Overview Job Title: Registered Nurse – Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months/Can be Extended Working hours: Day Shift Job Type: Subcon Pay Rate: Negotiable Position Description The Quality Analyst is responsible for ensuring the accuracy, compliance, and timeliness of appeal reviews through both manual and automated reporting mechanisms. This role supports continuous improvement in clinical operations by identifying quality gaps, performing root cause analysis, and recommending corrective actions. Key Responsibilities Review appeal cases and supporting documentation to ensure completeness and compliance with InterQual and contractual guidelines. Conduct manual audits and reporting to assess quality of appeal decisions and documentation. Analyze operational data and performance metrics to identify trends, errors, and improvement opportunities. Collaborate with clinicians and MD reviewers to validate decisions and escalate complex cases. Maintain dashboards and SLA tracking for appeals turnaround time, audit coverage, and accuracy. Support calibration sessions and feedback loops with transaction monitors and team leads. Document findings and prepare reports for internal and client-facing reviews. Ensure compliance with NCQA, CMS, and state regulations. Qualifications Education/Experience Bachelor’s degree in healthcare, life sciences, or related field preferred 2+ years of experience in appeals, grievance, or quality assurance in a healthcare setting Experience with audit tools, EMR systems, and reporting platforms Licensure/Certification Valid RN, LPN, or LVN license in applicable state (Florida) Skills Strong analytical, leadership and documentation skills Proficiency in Excel and data visualization tools Familiarity with InterQual criteria and CMS guidelines Ability to work independently and manage multiple priorities Additional Details Seniority level: Mid-Senior level Employment type: Contract Job function: Health Care Provider Industries: Hospitals and Health Care and Public Health #J-18808-Ljbffr Compunnel Inc.
$90k - $99k
DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL, US, 99999 Work Mode: Virtual (Exception only) It takes... .... Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs....ClaimsRemote jobFull timeWork from homeFlexible hours- A healthcare quality organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The ideal candidate will have a BSN and an active RN license, along with experience in medical record review. Responsibilities include evaluating...ClaimsRemote jobHourly payPart timeFlexible hours
$90k - $99k
A leading healthcare solutions provider seeks a DRG Nurse Reviewer Appeals and Hearings to coordinate appeal duties and engage in hearings, both virtual and on-site. Candidates must have an active RN license and coding certification. This remote role offers flexibility...SuggestedRemote workFlexible hoursGainwell Technologies
Florida, NY3 days ago$40 per hour
Nurse Reviewer PT (20‑30 hours week) - Remote Work Environment Non‑Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer... ...medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records...ClaimsContract workWork at officeLocal areaImmediate startRemote work- ...organized Manager of Clinical Appeals to lead our clinical... ...background in clinical review, medical necessity... ...effective resolution of denied claims, supporting revenue... ...and support a team of nurses, clinical reviewers,... ...improvement. Qualifications: Registered Nurse (RN) or clinical...ClaimsRemote work
Health Business Solutions
Florida, NY3 days ago - ...our clinical and revenue integrity teams. This role focuses on reviewing patient charts for accuracy, completeness, and compliance prior... ...Collaborate with coding, billing, and clinical staff to support clean claims Collaborate and assist our Authorizations and Referrals Dept...ClaimsFull timeWork at office
East Florida Eye Institute
Florida, NY2 days ago - ...responsible for the company’s third‑party medical claims processing and assisting patients and... ...information on pending claims Sends appeal letters to insurance Obtains authorizations... ...superior attention to detail Ability to review documents for accuracy and reasonability...ClaimsPermanent employmentTemporary workWork at office
EyeSouth Partners
Florida, NY5 days ago - ...Every Claim Represents Care. Every Dollar Recovered Supports Access. At My Psychiatrist... ...carriers to obtain claim resolution Submit appeals and supporting documentation as needed... ...revenue that might otherwise be lost Claim Review & Payment Analysis Review Explanation of...ClaimsWork at office
My Psychiatrist, LLC
Florida, NY3 days ago - ...would have a strong understanding of medical claims billing. This individual will also be... ...that all denied claims are corrected or appealed, and provide appropriate feedback to management... ..., appeals, and account reviews Takeappropriate followup actions onaccounts...ClaimsWork at office
$47k - $52k
...maximizing reimbursement through proactive claim follow-up, denial resolution, payment... ...denials by submitting corrected claims, appeals, reconsiderations, and supporting documentation... ...in accordance with payer requirements. Review claim edits and rejections to ensure...ClaimsDaily paidFull timeContract workRemote workWork from homeMonday to FridayOshi Health, Inc.
Florida, NY3 days ago- ...expert investigative services. We investigate all types of insurance claims including workers' compensation, suspected fraud, liability and... ...of an assignment based upon the case manager's instructions Review all case materials prior to conducting investigative activity Complete...ClaimsFlexible hours
J T Becker & Co Inc
Florida, NY3 days ago $14 - $16 per hour
...Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description Review and analyze insurance claims with accounts receivable balances that have aged beyond 30 days old or claims denied in the Insurance Follow-Up...ClaimsPrivate practiceHealthCare Support
Florida, NY2 days ago- ...Claims Counsel will handle title insurance and related claims. The ideal candidate should have strong communication skills, both verbal... ...Participate in mediations and other required court appearances. Review and approve invoices for costs and attorneys' fees. Perform and...ClaimsFull timeFlexible hours
Westcor Land Title Insurance Company®
Florida, NY17 hours ago - ...authorization Contacts providers with authorization, denial, and appeals process information as necessary Receive pended claims reports on claims received without prior authorization to research and review eligibility and benefit coverage Post payment, adjustments, and...ClaimsFull time
My Billing Company
Florida, NY4 days ago - ...to start their healthcare career in a supportive, technology-forward environment. You’ll gain real-world experience processing claims, reviewing patient data, and applying accurate billing codes — all while learning from experienced mentors in the field. What You’ll Do...ClaimsFull timePart timeRemote work
Itlearn360
Florida, NY17 hours ago - ..., you will be responsible for managing and processing insurance claims efficiently and effectively. You will act as a liaison between clients... ...claims recovery — Join our subrogation team! Responsibilities Review and assess insurance claims submitted by clients. Communicate...ClaimsBi-weekly payHourly payFull timeMonday to Friday
Lotane & Associates, P.A.
Florida, NY3 days ago - ...based in Pembroke Pines, FL. This role is responsible for reviewing and processing claims and ensuring accurate reimbursement from commercial... ...analyzing billing data, resolving claim denials, submitting appeals, and following up with payers to secure timely payments....ClaimsFull time
Better Billing Solutions
Florida, NY3 days ago $16 - $19 per hour
...benefits for pharmacy and medical third party claims for assigned cases. May communicate with... ...to keep them continuously informed. Review for accuracy of prescribed treatment regimen... ...submission of authorization. Facilitate appeals process between the patient, physician...ClaimsWork at officeCiNQ Recruitment LLC
Florida, NY4 days ago$22 per hour
...deadlines.Job responsibilities include, but are not limited to: Follow up on dental insurance claims. Posting insurance claim payments as needed. Resolve claim denials, appeals, and aging accounts. Managed provider credentialing and recredentialing with insurance...ClaimsHourly payFull timeWork at office- ...Commercial Auto personal injury cases. At Zurich North America Claims we prioritize work‑life balance and flexibility. The hybrid work... ...calculating exposure for clients Knowledge of billables, diary review, and substantive and procedural law Understanding of the staff counsel...ClaimsTemporary workWork at office
Zurich North America
Florida, NY5 days ago - ...appointments for multiple providers in the office File patient insurance claims and follow up on outstanding claims, verification of benefits... ...insurance and patient payments and process accounts receivables Review treatment plan fees and payment options with patients Partner...ClaimsDaily paidWork at office
Parkland Family Dentistry
Florida, NY3 days ago - ...in . These prestigious honors come after the organization was reviewed among 1.5 million large and mid-sized companies in a nationwide... ...appointments for multiple providers in the office File patient insurance claims and follow up on outstanding claims, verification of benefits...ClaimsDaily paidWork at office
South Broward Dentistry
Florida, NY4 days ago - ...Responsibilities Process medical billing claims, collect patient or provider payments, and... ...questions. Process patient refunds and appeals including re‑determinations and resubmissions... ...rectify issues with payers or patients. Review returned supplies to determine exchange,...ClaimsContract workWork at officeShift workWeekend workAfternoon shift
MILLENNIUMSOFT
Florida, NY16 hours ago - ...they are desperately needed. Responsibilities Review and manage assigned AR inventory to ensure timely follow-up on outstanding claims. Investigate and resolve denials,... ...and internal teams. Submit corrected claims, appeals, and additional documentation as required to...ClaimsFlexible hours
ICBD
Florida, NY1 day ago $140k - $165k
.... Work Arrangement The position is part of Zurich North America Claims, which values work‑life balance and flexibility. The hybrid work... ...clients Efficient work habits, knowledge of billables and diary review, substantive and procedural legal knowledge Understanding of the...ClaimsFull timeTemporary workWork at officeRemote workWork from homeVisa sponsorshipZurich North America
Florida, NY17 hours ago$110k - $140k
...evaluating physical damage and business income losses from catastrophic events. Projects include reviewing financial and industry data, revenue and expense projections, insurance claim evaluations, economic damage assessments, fraud and fidelity investigations, and forensic...ClaimsWork at officeLocal areaFlexible hoursNight shiftMeaden & Moore
Florida, NY1 day ago$140k - $165k
.... Work Arrangement The position is part of Zurich North America Claims, which values work‑life balance and flexibility. The hybrid work... ...clients Efficient work habits, knowledge of billables and diary review, substantive and procedural legal knowledge Understanding of the...ClaimsFull timeTemporary workWork at officeRemote workWork from homeVisa sponsorshipZurich North America
Florida, NY1 day ago- ...asset valuation analyses, preparing and reviewing property tax filings, analyzing assessments... ..., M&A due diligence, and property tax appeals. Job Duties & Responsibilities Prepares... ...regarding filings, compliance, and other claims. Prepares tax calculations to support...ClaimsFull timeFor contractorsLocal areaRelocation
NextEra Energy Resources
Florida, NY1 day ago - ...’s purpose is to process medical billing claims of low to moderate complexity, collect patient... ...patient refunds. They also handle appeals to include re-determinations and resubmissions... ...accurate and timely claim resolution. Review and analyze A/R balances to ensure timely...ClaimsWork at office
MyCare Medical
Florida, NY4 days ago - ...revenue cycle process, including billing, claims management, collections, denials, payment... ...claims submission, collections, denials, appeals, and payment posting. Monitor revenue... ...with operations, admissions, utilization review, clinical, and finance teams to ensure accurate...ClaimsContract work
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