Medical Reviewer, Registered Nurse

J29, Inc • Millersville, MD

8d • $65,000 - $80,000 • Remote

About The Position

At J29, we believe in empowering our employees to do great things for the benefit of others. Our culture is built on purpose, service, and impact — not just for our clients, but for our communities. We are a mission-driven, people-first organization that believes strong culture, thoughtful leadership, and meaningful philanthropy are inseparable from business success.

Requirements

• 5+ years of direct medical coding or medical billing experience, specifically in a healthcare environment.
• 3+ years working in a productivity-based claims or case working environment, out of a queued case management system.
• 3+ years working remotely with various technology systems. Ideally, candidate will have 3+ years of Medicare Fee For Service (FFS) experience in a medical coding role or program.
• Active license as a Registered Nurse, in good standing, in the United States (as verified by Nurses). Verified regularly.

Nice To Haves

• Experience with low-code, no-code case management systems as an end-user is preferred but not required.

Responsibilities

• RVC Reviewers perform both automated and complex reviews of Medicare Fee-for-Service (FFS) claims—including Part A/B, DMEPOS, and Home Health/Hospice—to assess overpayments, underpayments, and proper payments as determined by Recovery Audit Contractors (RACs).
• They apply Medicare policies and guidelines, ensuring claims are evaluated according to National and Local Coverage Determinations and CMS rules, and document clear, accurate findings for each claim.
• Reviewers participate in dispute resolution by re-examining claims and providing supporting documentation, support quality assurance through audits and ongoing training, and maintain compliance with CMS security and privacy standards.
• They also collaborate closely with key personnel to ensure consistency, accuracy, and continuous process improvement in all review activities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 1-10 employees