Medical Review Nurse Analyst (Remote)

About the role

The Medical Review Nurse Analyst conducts clinical reviews of medical records to verify compliance with Medicare and payer guidelines. Working remotely, you will ensure accurate billing, appropriate reimbursement, and provide education to providers on documentation standards.

Key responsibilities

• Perform detailed reviews of medical records to assess medical necessity and correct coding.
• Analyze submitted claims for compliance with Medicare guidelines and correct reimbursement.
• Prepare written clinical summaries with clear rationale for approvals, denials, or modifications.
• Educate providers through the Targeted Probe and Educate (TPE) program and monitor their progress.
• Stay up‑to‑date with federal, state, and CMS regulations, as well as company policies.

Required profile

• Associate’s or Bachelor’s degree in Nursing (BSN) with an active RN license in good standing.
• At least one year of clinical experience in a hospital, homecare, skilled nursing, or similar setting.
• Excellent written and verbal communication skills.
• Strong attention to detail and ability to manage multiple cases simultaneously.

Required skills

• Microsoft Outlook
• Microsoft Teams
• Microsoft OneNote
• Microsoft Word
• Microsoft Excel

What we offer

• Remote work option across multiple approved states.
• Performance bonus and merit increase opportunities.
• 401(k) retirement plan.