Registered Nurse Medical Reviewer

A company is looking for a Medical Review Specialist IV. Key Responsibilities Review and analyze Medicare claims and associated medical records for payment determinations Conduct in-depth claims analysis to detect potential fraudulent billing practices Complete summary reports and maintain compliance with departmental and regulatory guidelines Required Qualifications Registered Nurse (RN) with current licensure in one or more states or D.C At least 4 years of clinical experience Minimum of 7 years of claims knowledge from billing, reviewing, or processing Medical review experience required; fraud review/investigation experience preferred No adverse actions pending or taken against licensure and no conflict of interest

May 19, 2025 - 22:40

A company is looking for a Medical Review Specialist IV. Key Responsibilities Review and analyze Medicare claims and associated medical records for payment determinations Conduct in-depth claims analysis to detect potential fraudulent billing practices Complete summary reports and maintain compliance with departmental and regulatory guidelines Required Qualifications Registered Nurse (RN) with current licensure in one or more states or D.C At least 4 years of clinical experience Minimum of 7 years of claims knowledge from billing, reviewing, or processing Medical review experience required; fraud review/investigation experience preferred No adverse actions pending or taken against licensure and no conflict of interest