Medical Review Nurse II - SNF/MDS Auditor

Machinify
United States
Workplace: RemoteFull timeUSD 85,000 - 100,000 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 5+ yearsSkills: ["Written communication","Verbal communication","Attention to detail","Time management","Independent work"]

Perform skilled nursing facility (SNF) medical claims audits as a Medical Review Nurse, conducting retrospective and prepayment reviews for government and commercial payers. Apply SNF medical review guidelines to determine medically appropriate services, document findings, generate audit letters, and support appeal reviews when needed. Collaborate with clients and internal teams to improve medical policies, provider education, and system edits, while staying current on clinical, technology, and regulatory changes.

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FursaFursa
Machinify
Machinify
4 days ago

Medical Review Nurse II - SNF/MDS Auditor

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Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 8 hours agoStatus: Live

Job Summary

Perform skilled nursing facility (SNF) medical claims audits as a Medical Review Nurse, conducting retrospective and prepayment reviews for government and commercial payers. Apply SNF medical review guidelines to determine medically appropriate services, document findings, generate audit letters, and support appeal reviews when needed. Collaborate with clients and internal teams to improve medical policies, provider education, and system edits, while staying current on clinical, technology, and regulatory changes.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Mid level

Key Responsibilities

  • •Audit SNF claims for medically appropriate services using medical review guidelines, policies, and rules.
  • •Document audit findings with references to the applicable policies and rules.
  • •Generate letters that articulate audit findings and support findings during the appeals process when requested.
  • •Collaborate with the audit team and stakeholders to identify and approve vulnerabilities/cases for potential abuse.
  • •Assist with QA functions and training, and help establish edit parameters, new issue packets, and Medical Review Guidelines.

Pay and Benefits

Salary: USD 85,000 - 100,000 annually

Key Requirements

  • •Active unrestricted RN license in good standing (required).
  • •One or more years of experience with MDS/RAI process (required).
  • •One or more years performing medical records review and health care claims expertise tied to ICD-9/ICD-10 coding guidelines and the MDS RAI process (required).
  • •Experience with ICD-9, ICD-10, and HCPCS coding, plus comprehension of UB-04 and its application to the MDS billing process (required).
  • •Minimum five years diversified nursing experience providing direct inpatient or outpatient care, and must not be sanctioned or excluded from Medicare by the OIG (required).
Experience:5+ yearsHealthcareSkilled nursingMedical claimsMDS/RAIMedicare
Skills:Written communicationVerbal communicationAttention to detailTime managementIndependent work
Licenses:RN license
Tech Stack:ICD-9ICD-10HCPCSPDPMHIPPSRUGUB-04Microsoft WordMicrosoft ExcelMicrosoft PowerPointMicrosoft OfficeMedicare Benefit Payment ManualMedicare Claims Processing Manual

Company Brief

Machinify
Provides AI-driven predictive maintenance and asset-monitoring solutions for manufacturing and industrial operations, using IoT sensor data and machine learning to reduce downtime, optimize performance, and extend equipment life.
Industry: Industrial Automation
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