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Remote Insurance Utilization Review Jobs in Texas

Dane Street, LLC

Certified Professional Coder

Houston, TX · Remote

$21.75 - $29/hr

Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS) Conduct utilization reviews to ... Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We ...

Ourhrconnect

$309K - $413K/yr

Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite ... Life Insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations

Ourhrconnect

$309K - $413K/yr

Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite ... Life Insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations

SUN Behavioral Houston

Remote Intake Coordinator

Houston, TX · On-site +1

$17.25 - $23.50/hr

... insurance company/third-party payor. Able to work through and accept referrals through various ... Demonstrates understanding of utilization review process to include treatment criteria and ...

Corvel

Payment Integrity Analyst II

Fort Worth, TX · Remote

$66K - $101K/yr

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Reviews, analyzes, and ... Prospective, concurrent and retrospective utilization review * 1+ years healthcare revenue cycle ...

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Remote Insurance Utilization Review information

What is a remote insurance utilization review?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

What skills and qualifications are needed for a remote insurance utilization review specialist?

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

What are the most commonly searched types of Insurance Utilization Review jobs in Texas?

The most popular types of Insurance Utilization Review jobs in Texas are:

What are popular job titles related to Remote Insurance Utilization Review jobs in Texas?

For Remote Insurance Utilization Review jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Remote Insurance Utilization Review jobs in Texas look for?

The top searched job categories for Remote Insurance Utilization Review jobs in Texas are:

What cities in Texas are hiring for Remote Insurance Utilization Review jobs?

Cities in Texas with the most Remote Insurance Utilization Review job openings:

Remote Insurance Utilization Review jobs near you
Infographic showing various Remote Insurance Utilization Review job openings in Texas as of September 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Certified Professional Coder

Houston, TX • Remote

Dane Street, LLC
Insurance Actuarial and Claim Adjusting Services • 51 - 200 employees
Learn more about Dane Street, LLCexternal

$21.75 - $29/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 17 days ago

Key responsibilities

  • Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS).

  • Conduct utilization reviews to assess medical necessity and documentation compliance.

  • Review medical records and billing for payer disputes, recoupments, and appeals, and prepare detailed audit reports.

Job description

MUST ALREADY HAVE EXPERIENCE DOING BILL AUDIT REVIEWS FOR DIFFERENT STATES.

We are seeking an experienced CPC-certified medical coder with multi-state experience to perform coding audits, utilization reviews, demand package reviews, and provide litigation support including deposition and testimony services as needed. The ideal candidate must have experience reviewing medical records and billing across multiple states and payer environments.

Responsibilities:

Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS)

Conduct utilization reviews to assess medical necessity and documentation compliance

Review the medical portion and prepare the billing and coding review portion of demand package reviews for personal injury and insurance cases

Analyze medical records for payer disputes, recoupments, and appeals

Prepare detailed, defensible written audit reports

Provide expert review, affidavit support, deposition preparation, and testimony when required

Interpret CMS guidelines, LCD/NCD policies, and state-specific Medicaid and commercial payer rules

Review E/M services under 2021+ guidelines

Identify compliance risks and documentation deficiencies

Requirements

  • Active CPC certification through the American Academy of Professional Coders (AAPC)
  • CPMA strongly preferred
  • Minimum 5-7 years of professional coding experience
  • Documented experience performing audits or utilization reviews in multiple states
  • Strong knowledge of CMS regulations and state Medicaid variations
  • Experience with Medicare, Medicare Advantage, and commercial payer audits
  • Prior demand package review or litigation support experience required
  • Deposition and/or expert testimony history preferred
  • Excellent written reporting and analytical skills
  • Ability to work independently and meet strict deadlines
  • Preferred Experience:
  • RAC, UPIC, or commercial payer audit response
  • Multi-state Medicaid policy interpretation
  • Expert witness experience in civil litigation
  • Data analysis and audit trend reporting
  • This position may be structured as part time Candidates must be comfortable reviewing policies and payer rules across multiple jurisdictions and is able to do multiple types of reviews/audits

Benefits

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace. 

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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