Medical Claims Reviewer, 6 Month Contract (Remote)

The role

The Medical Review Nurse will conduct medical reviews by comparing End Stage Renal Disease patient medical records to CMS and CDC systems. They will determine and classify discrepancies based on error type and severity.

What you will do

• Conduct ESRD medical record reviews comparing medical record documentation to EQRS and NHSN
• Determine and classify discrepancies found based on the type and severity of errors
• Participate in quality control activities to support corporate and team objectives
• Assist with special projects or responsibilities as assigned by management

Required qualifications

• Active, unrestricted RN licensure in the United States and in the state of hire OR active compact multistate unrestricted RN license
• Associate Degree in Nursing OR Graduate of an accredited School of Nursing
• Two years of clinical experience plus two years of experience with utilization/medical review, quality assurance or end stage renal disease/dialysis
• Strong clinical background in dialysis, managed care, home health, rehabilitation, and/or medical-surgical settings
• Knowledge of specific criteria/protocol sets and the ability to use them effectively
• Proficiency with word processing software and Microsoft Office
• Ability to work independently, prioritize tasks, and make sound decisions
• Excellent customer service, communication, organizational, and critical thinking skills
• Ability to handle confidential information with discretion
• Proficient with computers, including the ability to use multiple screens and programs simultaneously
• High-speed internet (non-satellite)
• Private, lockable home office

Nice to have

• Three years of clinical nursing experience in End Stage Renal Disease/Dialysis

Benefits

• 401(k) and company match
• PTO that grows the longer you stay
• Health, Vision, Dental
• Company provided Life Insurance and Voluntary Life Insurance
• Short Term Disability and Long Term Disability

Before you apply

• Broadway Ventures conducts background checks and drug testing prior to the start of employment
• Some positions may also require fingerprinting
• Cannot consider applicants who live in California, Colorado, Connecticut, the District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New York, North Dakota, Ohio, Oregon, Rhode I

About the company

Broadway Ventures is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB) that provides program management, technology, and consulting solutions to government and private sector clients.