Medical Claims Reviewer
$67.7k/y-$67.7k/y
4 days ago
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RemoteFull-timeSenior
Summary
BROADWAY VENTURES, LLC is seeking a Medical Claims Reviewer to join their team in a remote work environment. The role involves conducting medical reviews for pre-pay and post-pay claims across various medical services.
About the Role
As a Medical Claims Reviewer, you will be responsible for reviewing medical claims for services such as Radiology, Ambulance, Physical Therapy, and Surgical. You will utilize clinical information and established guidelines to document decisions, determine medical necessity, and provide support for medical claims and utilization practices. This position requires occasional travel to the Augusta, GA office and is part of a subcontract with Palmetto GBA.
About You
Required:
- Active, unrestricted RN licensure from the United States and in the state of hire.
- Bachelor's degree in Nursing from an accredited School of Nursing.
- Five years of clinical experience, including two years in utilization/medical review, quality assurance, or home health.
- Strong clinical experience in home health, rehabilitation, and/or broad medical surgical experience.
- Working knowledge of managed care and various health care delivery systems.
- Proficiency in Microsoft Office.
Preferred:
- Master's degree in Nursing or similar.
- Five years of clinical nursing experience in Home Health, Utilization or Medical Review or Quality Assurance.
- Computer proficiency to include use of multiple screens and programs simultaneously.
Benefits
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
- Work from home
BROADWAY VENTURES, LLC
We deliver expert program management, cutting-edge IT, cybersecurity, and consulting solutions for government and commercial clients. Our mission is to drive efficiency and sustainable value, empowering underserved communities and ensuring a lasting impact across sectors such as defense, healthcare, and environmental sustainability. We are an 8(a) certified, HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB) dedicated to excellence and innovation.
Augusta, GA