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National Provider of IME and Medical Peer Review Services
RN Coder, Registered Nurse
Location
United States
Posted
109 days ago
Salary
0
Seniority
Senior
Job Description
RN Coder, Registered Nurse
Dane Street
• Conduct comprehensive utilization reviews to determine medical necessity and level of care • Review medical records for documentation completeness and clinical appropriateness • Evaluate inpatient, outpatient, and procedural services for compliance with payer guidelines • Assist with preparation and review of demand packages for legal and insurance cases • Analyze cases involving payer disputes, denials, and recoupments • Prepare detailed, defensible written clinical review reports • Provide affidavit support, deposition preparation, and testimony when required • Interpret CMS guidelines, Medicare policies, and state-specific Medicaid requirements • Identify clinical risk, quality-of-care concerns, and documentation deficiencies
Job Requirements
- Active, unrestricted Registered Nurse (RN) license
- Minimum 5–7 years of clinical experience
- At least 3–5 years of utilization review, medical necessity review, or case review experience
- Demonstrated experience performing reviews in multiple states
- Strong knowledge of Medicare, Medicare Advantage, Medicaid, and commercial payer criteria
- Experience applying InterQual or MCG guidelines preferred
- Prior litigation support, deposition, or expert testimony experience strongly preferred
- Excellent written analytical and report-writing skills
- Ability to work independently and meet strict deadlines
- Experience with inpatient and outpatient level-of-care determinations
- Appeals and denial review experience
- Experience supporting personal injury or civil litigation cases
- Background in case management or compliance review
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