Registered Nurse/ Clinical, Billing & Coding Reviewer/ Remote
Full Time
Remote
Posted
Job description
Job #10551- Registered Nurse/ Clinical, Billing & Coding Reviewer/ Remote – New York State
General Responsibilities:
This individual will complete the full spectrum of activities related to Medicaid Utilization or Quality reviews as assigned. Thus, conduct final level insurance appeals and will be reviewing medical records.
Compensation and Benefits for the Registered Nurse/ Clinical Billing & Coding Reviewer/ Remote:
- The salary for this position is $45 - $50 /hour
Full-time Benefits:
- Vacation
- Major Holidays
- Personal Days
- Sick Days
- License Reimbursement
- 401K
- Family Medical Leave
Schedule
- Full-time – COMPLETELY REMOTE
- Monday to Friday (9 AM-5:30 PM); Saturday or Sunday Meeting (occasionally)
Requirements for Registered Nurse/ Clinical Billing & Coding Reviewer/ Remote
- Must have an active RN State license
- Must have 1-3 years of experience in Case Review, Utilization, Billing, and coding review type.
- InterQual and Milliman experience, required.
- Must be comfortable working on a computer. Familiar with Outlook, spreadsheets, Word.
Responsibilities for Registered Nurse/ Clinical Billing & Coding Reviewer/ Remote
- Conduct utilization reviews up to and including the appeal level. This includes chart screen, completing electronic worksheets, entering the required information, and making level one denial decisions when necessary.
- Conduct quality and clinical study data collection reviews.
- Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures.
- Participate in collaborative training specific to clinical study objectives.
- You will be using InterQual criteria to review the medical records of inpatient high cost hospital stays for admission and acute level of care.
- You'll also review and validate itemized bills and need to have the ability to write up responses to send to the hospital.
- Other activities as may be deemed necessary
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