REMOTE ROLE - Registered Nurse - Medical Claims Reviewer (FES Claims) - RNMCR 25-21666 Job at NavitsPartners, Chandler, AZ

MCswWGZhd1UxRDl4NlJBNmRiRTNBR0o4
  • NavitsPartners
  • Chandler, AZ

Job Description

Job Title: Registered Nurse – Medical Claims Reviewer (FES Claims)

Duration: 13 Weeks
Schedule: 8-hour shifts | 8:00 AM – 05.00 PM | No Weekends 

Location: REMOTE (Willingness to attend 1–2 onsite training sessions if required)

Must Have: Access to a personal laptop (remote desktop access will be provided)

Certifications Required:

  • Active RN License (Arizona)

  • Basic Life Support (BLS)

  • Fingerprint Clearance Card (must be obtained before start)

Job Summary:

We are seeking a highly motivated and detail-oriented Registered Nurse to serve as a Medical Claims Reviewer for FES 1500 claims. This position involves evaluating emergency medical claims to ensure accuracy, compliance with standards, and appropriate reimbursement practices. Candidates must be capable of working remotely with a high level of independence and discretion.

Key Responsibilities:

  • Conduct thorough reviews and adjudication of FES 1500 claims in line with standard industry guidelines

  • Evaluate claims for emergency criteria, medical necessity, correct coding, length of stay, and level of care

  • Collaborate with providers for second-level review when required

  • Analyze claims data for reporting, trend identification, and savings tracking

  • Participate in special projects and conduct research when assigned

  • Apply InterQual criteria, CCI edits, and relevant regulations during claim assessments

Required Knowledge & Competencies:

  • Strong foundation in nursing practice, utilization review, and case management

  • Proficiency in CPT, HCPCS, ICD-9 (ICD-10 preferred) coding systems

  • Ability to assess medical documentation to determine appropriate care levels

  • Knowledge of managed care protocols, InterQual Criteria, and CCI edits

  • Understanding of AHCCCS and CMS regulatory requirements

  • Competent in data entry and statistical analysis

  • Independent worker with strong collaboration and communication skills

Additional Requirements:

  • Access to a personal laptop (remote desktop access will be provided)

  • High school diploma or equivalent

Job Tags

Remote job, Shift work,

Similar Jobs

Cross Border Talents

German-Speaking Customer Support Specialist (B2+) - Relocate to Malta! ️️ Job at Cross Border Talents

 ...German-Speaking Customer Support Specialist (B2+) - Relocate to Malta! Start Your Mediterranean Career Adventure! Were looking for German speakers to join our dynamic international team in sunny Malta with full relocation support! Your Relocation Package... 

Meals on Wheels of San Francisco

General Kitchen Sanitation Job at Meals on Wheels of San Francisco

Apply Here: POSITION / TITLE : General Kitchen Sanitation RESPONSI BLE TO : Fleet & Facilities Manager STATUS: Non-Exempt, Full-Time M-F PROGRAM ADDRESS : 2230 Jerrold Avenue, San Francisco CA 94124 MISSION : Meals on Wheels provides...

OhioHealth

Certified Pharmacy Technician Specialist - 50/50 Med History, Riverside Job at OhioHealth

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy...

SmartFinancial

Inside Sales Representative Job at SmartFinancial

 ...Join SmartFinancial: Empowering Insurance Agents with Cutting-Edge Technology Welcome to SmartFinancial, where our mission is clear:...  ...network of insurance partners. We are looking for the BEST sales talent out there. We offer Uncapped Commission : Our reps earn... 

OGS RESTAURANT

Restaurant Culinary / Kitchen Manager Job at OGS RESTAURANT

 ...make sure all food is served fresh warm and presentable in platesmake sure all call in orders are properly shared and all Uber eats and Grubhub delivery orders are properly shared and done promptly We are looking for an individual that has very good people...