Medical Claims Reviewer, 6 Month Contract (Remote)

Compensation rate: $32.5K/$31.25/hr. 6 month salary basis

We are seeking a dedicated RN to conduct medical reviews to perform comparisons between End Stage Renal Disease patient medical records documentation and data submitted to the Centers for Medicare and Medicaid Services (CMS) End Stage Renal Disease Quality Reporting System (EQRS) and the Centers for Disease Control (CDC) National Healthcare Safety Network (NHSN) based on the approved data validation methodology. Determine and classify discrepancies found based on the type and severity of errors. Common error categories might include missing data, incorrect values, and data entered in the wrong fields.

Position Details

• Job Type: 6 Month Contract, possibility for extension/conversion
• Duration: Target; November 2026  – May 2027
• Schedule: Monday-Friday, 8:00 AM – 4:30 PM (40 hours/week)
• Location: Remote U.S. (Work from home)
• Requirements for Remote Work: High-speed internet (non-satellite) and a private, lockable home office.

Key Responsibilities

• Conduct ESRD medical record reviews comparing medical record documentation to EQRS and NHSN to determine accuracy and timely reporting.
• Determine and classify discrepancies found based on the type and severity of errors. Common error categories might include missing data, incorrect values, and data entered in the wrong fields.
• Participate in quality control activities to support corporate and team objectives.
• Assist with special projects or responsibilities as assigned by management.

Minimum Qualifications

• Licensure:
• Active, unrestricted RN licensure in the United States and in the state of hire
  OR
• Active compact multistate unrestricted RN license (as defined by the Nurse Licensure Compact).

• Education:
• Associate Degree in Nursing
  OR
• Graduate of an accredited School of Nursing.

• Required Experience: 
  • Two years of clinical experience plus two years of experience with utilization/medical review, quality assurance or end stage renal disease/dialysis.

• Skills:
• Strong clinical background in dialysis, managed care, home health, rehabilitation, and/or medical-surgical settings.
• Knowledge of specific criteria/protocol sets and the ability to use them effectively.
• Proficiency with word processing software and Microsoft Office.
• Ability to work independently, prioritize tasks, and make sound decisions.
• Excellent customer service, communication, organizational, and critical thinking skills.
• Ability to handle confidential information with discretion.
• Proficient with computers, including the ability to use multiple screens and programs simultaneously.

Preferred Qualifications

• Three years of clinical nursing experience in End Stage Renal Disease/Dialysis (strongly preferred).