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Professional Remote Rn Chart Review Jobs (NOW HIRING)

TEEMA Group

REMOTE RN - Quality Review

Phoenix, AZ · Remote

$42 - $43.50/hr

This is an excellent opportunity for a licensed clinical professional with experience in clinical ... Active, unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) * ...

MPF Federal

Telehealth RN - Evergreen

$35/hr

Accurately chart calls in our EHR and follow compliance protocols * Team Collaboration: Work closely with a supportive leadership team and fellow remote RNs If you're an experienced nurse with a calm ...

Centene

RN Supervisor, Appeals, Managed Care, UM

OR · On-site +1

$75K - $135K/yr

NOTE: REMOTE RN candidates may reside in any state but a current and active RN license from the ... Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team ...

Cortex

Remote RN Inbound Agent

$25/hr

We are seeking dedicated and qualified RNs to join our team as Remote Contingent Hurricane Response ... empathy and professionalism Quick learner with the ability to adapt to new platforms and ...

firsthand Health

Remote Triage Nurse

Boise, ID · Remote

The Triage Nurse is a remote Registered Nurse who provides telephone and electronic triage support to firsthand individuals and staff, while also supporting outpatient care coordination. This is ...

Perry Health Inc

$40/hr

Collaborate with the broader care team -- including RNs and Accountability Coaches -- to reinforce ... chart review time also counting toward this total. * Non-Clinical Pay: $30.00/hour flat rate for ...

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Professional Remote Rn Chart Review information

What is the difference between Professional Remote Rn Chart Review vs Medical Records Reviewer?

AspectProfessional Remote Rn Chart ReviewMedical Records Reviewer
CredentialsRegistered Nurse (RN) licenseVaries; often includes medical background or certification
Work EnvironmentRemote, healthcare-focusedRemote or onsite, administrative or healthcare settings
Industry UsageHealthcare, insurance, legal casesHealthcare, insurance, legal documentation
Job FocusReviewing patient charts for accuracy, compliance, and medical necessityReviewing medical records for completeness, accuracy, and compliance

The Professional Remote Rn Chart Review primarily involves licensed RNs analyzing patient charts for medical accuracy and compliance, often for insurance or legal purposes. Medical Records Reviewers may have a broader background and focus on verifying the completeness and correctness of medical documentation. While both roles are remote and healthcare-related, the RN chart review emphasizes clinical expertise, whereas medical records reviewers may not require nursing credentials.

What cities are hiring for Professional Remote Rn Chart Review jobs? Cities with the most Professional Remote Rn Chart Review job openings:
What are the most commonly searched types of Remote Rn Chart Review jobs? The most popular types of Remote Rn Chart Review jobs are:
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Professional Remote Rn Chart Review jobs near you

Clinical RN Chart Reviewer, (Remote) CIC or CCS certified

ProgenyHealth LLC

Remote

$90K - $120K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 9 days ago

Job description

Job Type
Full-time
Description
Job Role
The Clinical RN Chart Reviewer will perform clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered. The Clinical RN Chart Reviewer will report to the Payment Assurance Senior Manager and support a culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission. This role requires certified coding expertise and a strong understanding of DRG validation, medical necessity, and regulatory guidelines.
Requirements
Responsibilities will include:
  • Audits and analyzes neonatal intensive care unit (NICU) claims according to ICD-10 coding principles and clinical guidelines.
  • Analysis of claims data to optimize reimbursement by ensuring that the diagnosis codes, procedure codes, and supporting documentation accurately support the service rendered.
  • Ensures claims analysis complies with ethical coding standards, guidelines, and regulatory requirements.
  • Responsible for performing clinical reviews of medical records and other documentation to validate issues of claims coding accuracy, medical necessity, and the appropriateness of treatment settings and services delivered.
  • Utilize Clinical Review Tools and EMR Systems.
  • Research reimbursement regulations for claim payment compliance to support and validate audit findings.
  • Assist with the development of claims audit process documentation, including workflow diagrams, policies and procedures, and standard operating procedures.
  • Detect discrepancies in provider billing and recommend adjustments to ensure proper reimbursement.

Qualifications:
  • Registered Nurse required, preferable NICU
  • 2+ years with inpatient claims, required, preferably NICU and maternity
  • Inpatient Coding Certification required - CCS or CIC. If not currently certified, requirement to obtain CIC or CCS within 6 months of hire, applicant responsible for exam and associated fees*
  • Experience in nursing, inpatient coding and reimbursement guidelines, and specifically, has a solid understanding of the MS-DRG, AP-DRG and APR-DRG payment systems.
  • 2+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology.
  • Adherence to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
  • Requires expert coding knowledge - DRG, ICD-10, CPT, HCPCS codes.
  • Experience with appeals is strongly preferred.
  • Excellent communication skills, both oral and written.
  • Strong interpersonal skills that will support collaborative teamwork.
  • Proficient in Microsoft Office: Word and Excel; Access - highly preferred.
  • Ability to work independently and within a team.
  • Critical listening, thinking, decision making and problem solving.

Benefits
This position has a salary range of $90,000 - $110,000 annually based on relevant experience. Some of the benefits we offer our team are:
  • Paid Time Off
  • Paid Parental Leave
  • Medical, dental, vision benefits
  • 401K with company match
  • Short- and Long-Term Disability
  • Group Life Insurance
  • Tuition reimbursement
  • Professional development opportunities
  • Business Casual work environment
ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: careers@progenyhealth.com
Equal Opportunity Employer, including individuals with disabilities and veterans.
Salary Description
90,000 - 120,000

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