Medical Review Nurse Analyst

The Medical Review Nurse Analyst is responsible for conducting clinical reviews of medical records to ensure compliance with regulatory and payer guidelines. This role ensures that providers are billing and being paid appropriately for services provided based on Medicare guidelines. The Medical Review Nurse Analyst reviews claims and delivers provider education on current billing and documentation requirements.

Salary Range

$66,000 - $70,000

The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

Work Location

We are open to remote work in the following approved states:

Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin

How do I know this opportunity is right for me? You'll be:

Reviewing submitted claims to ensure that billed services are medically necessary and correctly coded based on Medicare guidelines.

Preparing written clinical summaries and determinations with clear rationale for approvals, denials, or modifications.

Educating providers in accordance with the Targeted Probe and Educate (TPE) program.

Monitoring the progress of assigned providers and educate on current billing and documentation requirements.

Ensuring compliance with federal and state regulations, CMS guidelines, and company policies.

Staying current on clinical guidelines, medical policy updates, and industry best practices.

What will I gain from this role?

Enjoying a work from home position with daytime hours, no on-call work, no travel, and holidays off

Collaborating with a team of both clinicians and non-clinicians

Deepening your understanding of Medicare and how the program works

Learning about our Hyland OnBase tool which is our content management system used for viewing electronic records

Experience working in an environment that serves our Nation's military, veterans, Guard and Reserves and Medicare beneficiaries

Working in a continuous performance feedback environment

Minimum Qualifications

Associate's Degree in Nursing (ASN) or Bachelor's Degree in Nursing (BSN).

Active RN license, applicable to state of practice in good standing.

1 or more years of clinical experience in a healthcare setting.

Excellent written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely.

Strong attention to detail and organizational skills to manage multiple cases simultaneously.

Basic knowledge and understanding of medical/clinical review processes.

Solid computer skills with experience working in multiple on-line systems including MS Outlook, Teams, OneNote, Word, and Excel.

Preferred Qualifications

Experience working for a Medicare Administrative Contractor (MAC).

Basic Medicare knowledge and/or experience.

Remote Work Requirements

Wired (ethernet cable) internet connection from your router to your computer

High speed cable or fiber internet

Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at

Please review Remote Worker FAQs for additional information

Benefits

Remote and hybrid work options available

Performance bonus and/or merit increase opportunities

401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)

Competitive paid time off

Health insurance, dental insurance, and telehealth services start DAY 1

Employee Resource Groups

Professional and Leadership Development Programs

Review additional benefits: (