Medical Reviewer – 1099 Contract

This is a fully remote position, open to applicants in United States.

📋 Description

• Perform thorough evaluations of home health pre-claim review (PCR) packages to assess adherence to Medicare coverage, coding, and payment standards.

• Record affirmation/non-affirmation results with clearly defined clinical justification in the specified case management system within 7 business days.

• Collaborate with providers, as authorized, to request or clarify necessary documentation.

• Report provider issues or suspected fraudulent activities following established program protocols.

• Achieve and maintain a 98% accuracy rate.

• Fulfill mandatory training, quality assurance assessments, and inter-rater reliability sessions.

⛳️ Requirements

• All RN Medical Reviewers must have an active, unrestricted RN license in their state of residence.

• A minimum of 2 years of clinical experience is required.

• At least 2 years of experience in home health, quality assurance, or utilization review is necessary.

• Experience in home health (OASIS, Medicare Conditions of Participation) or prior engagement with MAC/RCD/CMS program integrity is preferred.

• Proficiency in ICD coding is preferred.

• Candidates must complete background checks and drug testing before commencing employment.

• Some positions may necessitate fingerprinting.

🏝️ Benefits

• 401(k) with company matching.

• Paid Time Off (PTO) that increases with tenure.

• Health, Vision, and Dental insurance.

• Company-funded Life Insurance and optional Voluntary Life Insurance.

• Short Term and Long Term Disability coverage.