Machinify

1 day ago

Medical Review Nurse II - Home Health Auditor

✓ Verified Job

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

Source: Company careers pageValidated by: Fursa AI

Last checked: 21 hours agoStatus: Live

Job Summary

Perform retrospective and prepayment medical claims audits for Home Health in a remote, multi-location environment. Review claims for medical appropriateness using established utilization management guidelines and policies, document findings with referenced rules, and generate audit letters. Support audits during appeals when requested, stay current on clinical practice and regulatory changes, and collaborate with the audit team to improve workflows, QA, and training while cross-training across clinical areas.

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Seniority: Mid level

Key Responsibilities

•Audit claims for medically appropriate services in inpatient settings using medical review guidelines, policies, and rules.
•Document audit findings with references to the appropriate policies and rules.
•Generate letters that articulate audit findings.
•Support audit findings during appeals when requested.
•Collaborate with the audit team to identify and obtain approval for vulnerabilities/cases subject to potential abuse, and assist with QA and training.

Key Requirements

•2+ years of home health claims auditing, quality assurance and/or recovery auditing experience (3+ preferred).
•Associate or bachelor’s degree in nursing with an active/unrestricted RN license.
•Deep knowledge of ICD-9, ICD-10, CPT-4, or HCPCS coding.
•Experience using utilization management systems or clinical decision-making tools such as MCG or InterQual.
•Strong written/verbal communication skills and ability to independently manage desk audits and claims reviews while meeting strict deadlines.

Experience:2+ yearsHealthcareHome healthMedical codingClaims auditingUtilization management

Education:Bachelor's in Nursing

Skills:Attention to detailAnalytical skillsCritical judgmentWritten communicationVerbal communication

Licenses:RN

Certifications:CCDSCDIPCCSCIC

Languages:English

Tech Stack:ICD-9ICD-10CPT-4HCPCSMCGInterQualSharePointSlackOutlook CalendarEHR

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

Website

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Machinify

1 day ago

Medical Review Nurse II - Home Health Auditor

✓ Verified Job

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

Source: Company careers pageValidated by: Fursa AI

Last checked: 21 hours agoStatus: Live

Job Summary

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Seniority: Mid level

Key Responsibilities

•Audit claims for medically appropriate services in inpatient settings using medical review guidelines, policies, and rules.
•Document audit findings with references to the appropriate policies and rules.
•Generate letters that articulate audit findings.
•Support audit findings during appeals when requested.
•Collaborate with the audit team to identify and obtain approval for vulnerabilities/cases subject to potential abuse, and assist with QA and training.

Key Requirements

•2+ years of home health claims auditing, quality assurance and/or recovery auditing experience (3+ preferred).
•Associate or bachelor’s degree in nursing with an active/unrestricted RN license.
•Deep knowledge of ICD-9, ICD-10, CPT-4, or HCPCS coding.
•Experience using utilization management systems or clinical decision-making tools such as MCG or InterQual.
•Strong written/verbal communication skills and ability to independently manage desk audits and claims reviews while meeting strict deadlines.

Experience:2+ yearsHealthcareHome healthMedical codingClaims auditingUtilization management

Education:Bachelor's in Nursing

Skills:Attention to detailAnalytical skillsCritical judgmentWritten communicationVerbal communication

Licenses:RN

Certifications:CCDSCDIPCCSCIC

Languages:English

Tech Stack:ICD-9ICD-10CPT-4HCPCSMCGInterQualSharePointSlackOutlook CalendarEHR

Company Brief

Machinify

Industry: Industrial Automation

Website