Medical Claims Reviewer, 6 Month Contract (Remote)

Broadway Ventures

4d•Remote

About The Position

Broadway Ventures is seeking a dedicated RN to conduct medical reviews. This role involves comparing End Stage Renal Disease patient medical records documentation with 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). The primary goal is to identify and classify discrepancies based on an approved data validation methodology, determining the type and severity of errors such as missing data, incorrect values, or data entered in the wrong fields. This is a temporary contract position with the possibility of extension or conversion.

Requirements

Active, unrestricted RN licensure in the United States and in the state of hire OR Active compact multistate unrestricted RN license.
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.
High-speed internet (non-satellite) and a private, lockable home office for remote work.

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. 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.