Medical Reviewer, Register Nurse Coder

Key Responsibilities

The Medical Reviewer performs automated and complex reviews of Medicare Fee-for-Service claims to ensure payment accuracy and compliance with CMS guidelines. They also document findings, participate in dispute resolution, and support quality assurance through audits and training.

Requirements

Candidates must hold an active Registered Nurse license and possess at least 5 years of direct medical coding or billing experience. Proficiency in Medicare Fee-for-Service claims and experience with case management systems are required.

Qualifications

Experience

5+ years of experience

Key Skills