Regulatory Review Specialist, RN

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

📋 Description

• Assist with payer audits and the review of medical records, ensuring the prompt and precise submission of necessary documentation.

• Oversee medical review requests and appeals related to CMS contractors, regulatory bodies, and billing intermediaries.

• Assess clinical documentation utilizing established audit and submission checklists.

• Collaborate with operational and clinical teams to collect and verify essential records.

• Engage in chart reviews and compliance monitoring initiatives throughout the organization.

• Aid in risk identification activities and efforts to ensure regulatory compliance.

• Support investigations and corrective measures regarding compliance issues.

• Keep track of audit outcomes and documentation through reporting tools and systems.

• Navigate various EMRs, payer portals, and operational systems to handle submissions and appeals.

• Contribute to the development of training and educational resources that enhance compliance awareness across teams.

• Take part in internal quality, billing, and operational review activities.

• Complete other regulatory and administrative tasks as assigned.

⛳️ Requirements

• Current Registered Nurse (RN) license.

• At least 3 years of experience in clinical operational leadership or supervision in Home Health and/or Hospice.

• In-depth knowledge of CMS Home Health regulations and state/federal licensing standards.

• Experience in conducting clinical chart reviews and documentation audits.

• Ability to prioritize and manage tasks independently in a remote setting.

• Strong technical skills and proficiency in navigating various systems and portals.

• Exceptional communication, organizational skills, and follow-through.

• Preferred Experience: Involvement in medical review, appeals, audit responses, or utilization review.

• Familiarity with payer audits and contractor review processes.

• Experience in supporting compliance, quality, accreditation, or regulatory initiatives.

• Proficiency with EMR platforms and documentation tracking systems.

• Background in billing, reimbursement, or operational compliance functions.

🏝️ Benefits

• Medical, Dental, and Vision coverage.

• Pharmacy benefits.

• Virtual care and mental health support.

• Flexible Spending Accounts (FSA) and Health Savings Account (HSA).

• Supplemental health and life insurance.

• 401(k) with company match.

• Employee referral program.

• Prepaid legal services.

• Identity theft protection.

• Generous paid time off.

• Pet insurance.

• Tuition and continuing education reimbursement.