Arizona Licensed Medical Claim NurseVirtualVocations • Winston Salem, North Carolina, United States
Arizona Licensed Medical Claim Nurse
VirtualVocations • Winston Salem, North Carolina, United States
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A company is looking for an RN Medical Claim Review Nurse Remote.
Key Responsibilities
Perform clinical / medical reviews of medical claims and previously denied cases to ensure medical necessity and accurate billing
Validate member medical records and claims to ensure appropriate reimbursement to providers
Assist with complex claim reviews and provide clinical resource support for utilization management and member / provider inquiries
Required Qualifications
At least 2 years of clinical nursing experience, preferably in a hospital setting, with experience in utilization review or medical claims review
Active and unrestricted Registered Nurse (RN) license in the state of practice
Experience with applicable state, federal, and third-party regulations
Strong organizational and time-management skills
Proficiency in Microsoft Office and ability to learn new software programs
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Licensed Nurse Medical • Winston Salem, North Carolina, United States
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