Broadway Ventures - Medical Reviewer (1099 Contract) (Remote)

United States$60k - $65k3w ago

In Office Mid NA Payments Healthcare Physician Contract Review Ollama Quality Assurance Case Management Documentation

Requirements

• All RN Medical Reviewers must possess the following minimum qualifications: an active, unrestricted RN license in their state of residence. • A minimum of 2 years of clinical experience, along with at least 2 years of experience in home health, quality assurance, or utilization review. • Experience in home health (OASIS, Medicare Conditions of Participation) or prior involvement with MAC/RCD/CMS program integrity. • Proficiency in ICD coding. • What to Expect Next: • After submitting your application, our recruiting team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most qualified candidates. Broadway Ventures conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting.

Responsibilities

• Conduct comprehensive reviews of home health pre-claim review (PCR) packages to determine compliance with Medicare coverage, coding, and payment criteria. • Document review outcomes (affirmation/non-affirmation) with well-defined clinical rationale in the designated case management system, ensuring a turnaround time of within 7 business days. • Engage with providers, as authorized, to request or clarify documentation, and escalate any provider concerns or suspected fraud in accordance with established program procedures. • Maintain a standard of 98% accuracy and fulfill all required training, quality assurance reviews, and inter-rater reliability sessions.