Registered Nurse Review Analyst (Medicare Advantage)

TL;DR

Registered Nurse Review Analyst (Medicare Advantage): Approval or rejection of claims and benefit interpretation with an accent on clinical review and regulatory compliance. Focus on analyzing medical data, applying Medicare regulations, and utilizing CPT/HCPCS coding for claims processing.

Location: Remote (Must be local to Michigan, USA)

Salary: $36/HR

Company

hirify.global is a staffing firm providing specialized professional personnel for large-scale corporate clients.

What you will do

• Manage the approval or rejection of healthcare claims and benefit interpretations.
• Enter and reference clinical data via PC and Clinical Review Team terminals.
• Ensure all reviews align with Medicare regulations and clinical guidelines.
• Collaborate with the Clinical Review Team to maintain data accuracy.

Requirements

• Current unrestricted state of Michigan registered nurse license.
• Associate Degree or nursing diploma required (Bachelor’s Degree preferred).
• Minimum 2 years of RN patient care experience.
• Expertise in the use of medical terminology.
• Strong critical thinking skills.
• Must be based in Michigan.

Nice to have

• Experience in triage, case management, or rehabilitation.
• Knowledge of Medicare Advantage Part B.
• Familiarity with CPT/HCPCS coding and Medicare regulations.