Medical Claims Reviewer, 6 Month Contract

Broadway Ventures

100d

About The Position

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation. 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.

Requirements

• 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).
• Associate Degree in Nursing OR Graduate of an accredited School of Nursing.
• Two years of clinical experience plus two years of experience with utilization/medical review, quality assurance or end stage renal disease/dialysis.
• 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.

Nice To Haves

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

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.
• Participate in quality control activities to support corporate and team objectives.
• Assist with special projects or responsibilities as assigned by management.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree
• Number of Employees: 51-100 employees