Utility Management Nurses (Insurance Coding & Revenue Management)Mercor • Temecula, California, US
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Utility Management Nurses (Insurance Coding & Revenue Management)
Mercor • Temecula, California, US
1 day ago
Job type
- Part-time
- Remote
Job descriptionUtility 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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