Arizona Licensed Medical Claim Nurse

A company is looking for an RN Medical Claim Review Nurse Remote.

Key Responsibilities

Perform clinical / medical reviews of medical claims and previously denied cases to ensure medical necessity and accurate billing

Validate member medical records and claims to ensure appropriate reimbursement to providers

Assist with complex claim reviews and provide clinical resource support for utilization management and member / provider inquiries

Required Qualifications

At least 2 years of clinical nursing experience, preferably in a hospital setting, with experience in utilization review or medical claims review

Active and unrestricted Registered Nurse (RN) license in the state of practice

Experience with applicable state, federal, and third-party regulations

Strong organizational and time-management skills

Proficiency in Microsoft Office and ability to learn new software programs