Medical Claim Reviewer (CGS, DMEC-B) — Broadway Ventures
Broadway Ventures
Pay$65,000 / $31.25
LocationRemote - United States
Remote statusRemote
Phone levelLow phone
IndustryHealthcare / Government Claims Review
OccupationMedical Claim Reviewer
Job functionClinical Medical Review & Claims Determination
State restrictionsUnited States; active unrestricted RN license in state of hire or compact multistate RN license required
Eligible countriesUnited States
RegionNorth America
Job Summary
Performs pre- and post-payment medical reviews, evaluates medical necessity and reimbursement eligibility, reviews appeals and fraud referrals, and documents approval or denial rationales.
Job Description
Performs pre- and post-payment medical reviews, evaluates medical necessity and reimbursement eligibility, reviews appeals and fraud referrals, and documents approval or denial rationales.
Additional Requirements & Compensation
Work authorizationNot specified
LanguageStrong professional English communication
Time zoneNot specified
Additional Job Details
Clinical role requiring an active RN license plus two years of clinical experience. Associate Degree in Nursing or accredited nursing-school graduation required. High-speed internet and a private lockable home office are required.
Posting Information
Posted date2026-09-21