Utility Management Nurses (Insurance Coding & Revenue Management)Mercor • Cape Coral, Florida, US

Utility Management Nurses (Insurance Coding & Revenue Management)

Mercor • Cape Coral, Florida, US

23 hours ago

Job type

Part-time

Remote

Job description

###

Role Overview

We’re seeking experienced

Utility Management Nurses

to support a client’s healthcare product development by leveraging expertise in

insurance coding and hospital revenue management workflows

. This role involves collaborating with hospital systems to align medical documentation with insurance policies, ensuring accurate coding and optimal reimbursement outcomes. ###

Key Responsibilities

Insurance Coding & Revenue Cycle Alignment :

Review, audit, and optimize insurance coding practices across hospital systems to ensure compliance and maximize reimbursement accuracy. -

Workflow Analysis :

Evaluate existing revenue management workflows and recommend improvements tailored to client’s AI-driven documentation tools. -

Clinical Data Interpretation :

Translate complex clinical notes into standardized coding formats (ICD-10, CPT, HCPCS) aligned with payer policies. -

Policy Matching :

Assess coding accuracy against insurance guidelines and payer documentation requirements. -

Product Development Collaboration :

Work closely with client’s engineering and product teams to refine AI models that automate or assist with medical coding and documentation. -

Compliance & Quality Assurance :

Ensure alignment with HIPAA, CMS, and payer-specific coding regulations. ###

Required Qualifications

Licensure :

Registered Nurse (RN) or equivalent clinical background. -

Experience :

Minimum 3–5 years in

medical coding

clinical documentation improvement (CDI)

, or

revenue cycle management

. -

Certifications :

CPC, CCS, or CRC certification preferred. -

Domain Expertise :

Familiarity with

hospital billing systems

payer policy interpretation

, and

coding audit procedures

. -

Analytical Skills :

Strong understanding of clinical documentation standards and payer logic. -

Tech Savvy :

Comfortable working with EHR systems (Epic, Cerner, Meditech) and documentation review software. ###

Preferred Qualifications

Experience working within

hospital revenue integrity teams

insurance utilization management

. - Exposure to

AI-powered healthcare documentation tools

automated coding systems

. - Ability to identify and flag edge cases or policy exceptions in automated workflows. - Strong collaboration skills with cross-functional (engineering, compliance, and data) teams. ###

Engagement Model

Contract / Part-time (Remote / In person)

— Flexible hours with collaboration during U.S. business hours. In person in San Francisco is a plus

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Utility • Cape Coral, Florida, US

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