Nurse Educator/Review Coordinator (Healthcare)

TL;DR

Nurse Educator/Review Coordinator (Healthcare): Facilitating provider education based on claim reviews under the BFCC-QIO contract with an accent on Medicare policy and ICD-10 coding. Focus on reducing Medicare’s paid claims error rate through clinical education and medical record documentation reviews.

Location: Remote (Must be based in the US)

Salary: $93,000

Company

Data-centric transformation company elevating health outcomes through quality data-driven solutions and clinical expertise.

What you will do

• Collaborate with staff and the Medical Director to identify billing issues and recommend resolutions.
• Facilitate education sessions for providers on CMS-required medical record documentation for claim reviews.
• Perform desktop medical reviews and interpret applicable review criteria.
• Support physician reviewers by summarizing case facts and preparing case questions.
• Construct final claim review provider letters to improve provider compliance.
• Maintain patient confidentiality in compliance with HIPAA and HITECH standards.

Requirements

• Current licensure as a Registered Nurse (RN) or accreditation as a Health Information Management professional (RHIA, RHIT, CCS).
• Clinical background with experience in coding, claim reviews, or medical reviews.
• Experience with Medicare QIO, MAC, or RAC appeals is preferred.
• Strong ability to write clearly in the English language.
• Ability to organize multiple simultaneous tasks in a team environment.
• Proficiency in computer keyboarding and independent work.

Culture & Benefits

• Fully remote work position.
• Purpose-driven culture with straightforward communication and clinical expertise.
• Flexible and proactive work environment.
• Opportunity to impact health outcomes through data-driven process efficiency.