Senior Nurse Reviewer

📋 Description

• Conduct comprehensive clinical and billing reviews to verify the accuracy, appropriateness, and
• Review medical claims using UB-04 forms and detailed itemized statements to validate individual
• Verify itemized medical bill charges against client policies, applicable requirements, and industry
• Perform utilization and level-of-care reviews by analyzing medical records and applying established
• Evaluate clinical documentation to determine whether it supports the medical necessity of services
• Apply critical thinking and sound clinical judgment while meeting production targets and quality

🎯 Requirements

• Active, unrestricted Registered Nurse (RN) license in the United States and the state of primary
• At least 5 years of clinical experience in an inpatient hospital setting.
• At least 1 year of itemized medical bill review experience.
• Familiarity with CPT, ICD-10, and HCPCS coding guidelines.
• Strong clinical assessment, critical thinking, and decision-making skills.
• Ability to manage multiple tasks and meet productivity and quality targets in a fast-paced

🎁 Benefits

• Annual salary range of $78,000–$99,200, depending on geographic location, internal equity, relevant
• Flexible vacation policy for eligible full-time salaried employees.
• 401(k) retirement plan with employer matching contributions.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies.