Clinical Reviewer

RADcube - A NLogix Company • Indianapolis, IN

5d • Hybrid

About The Position

We are seeking a detail-oriented Clinical Junior Reviewer to support medical record and compliance reviews for Indiana Medicaid programs. This role is responsible for evaluating quality of care, identifying compliance issues, preparing audit documentation and reports, and supporting appeals activities. The ideal candidate brings clinical knowledge, regulatory awareness, and strong analytical and writing skills. This is a fully remote position with occasional onsite presence in Indianapolis, IN for audits or key meetings. Local candidates in or near Indianapolis are preferred. Travel is not regularly expected; any required onsite visits are pre-approved with expenses covered.

Requirements

• RN license preferred; Indiana license or compact license accepted.
• Coding certification such as CCS or CPC strongly preferred.
• Candidates located in or near the Indianapolis, IN area are preferred; full remote considered for strong candidates.
• At least 1 year of Medicaid experience or exposure as a clinician or clinical reviewer.
• At least 1 year of nursing or other clinical experience preferred.
• Knowledge of CPT coding guidelines and ICD-10 standards.
• Proficiency in Microsoft Excel, Word, and Outlook.
• Strong analytical, critical thinking, problem-solving, and technical writing skills.
• Ability to work independently and collaboratively in a fast-paced environment.
• Experience working with healthcare providers strongly preferred.
• Knowledge of healthcare claims data and fraud, waste, and abuse preferred.

Responsibilities

• Review medical records to evaluate provider compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulations.
• Conduct medical record and compliance reviews independently and provide preliminary findings to the Lead Clinical Reviewer.
• Maintain detailed workpapers documenting procedures performed, evidence reviewed, and conclusions reached.
• Assist with appeals as needed.
• Ensure all work aligns with state, federal, and national guidelines.
• Stay current on clinical guidelines, policies, regulations, and Indiana Medicaid updates.
• Research Indiana Medicaid rules and maintain internal repositories of bulletins, policies, and procedures.
• Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed