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Utility Management Nurses (Insurance Coding & Revenue Management)
Utility Management Nurses (Insurance Coding & Revenue Management)Mercor • Pontiac, Michigan, US
Utility Management Nurses (Insurance Coding & Revenue Management)

Utility Management Nurses (Insurance Coding & Revenue Management)

Mercor • Pontiac, Michigan, US
22 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
  • or
  • insurance utilization management
  • . - Exposure to
  • AI-powered healthcare documentation tools
  • or
  • 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 • Pontiac, Michigan, US

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