Medical Review Nurse - CMS/RAC Auditor, Government Audits

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

Source: Company careers pageValidated by: Fursa AI

Last checked: 7 hours agoStatus: Live

Job Summary

Join Machinify as Medical Review Nurse performing medical claims audit reviews for government payers. You will work remotely in a fast-paced, multi-location team to audit inpatient and outpatient claims, document findings, generate audit letters, and support appeals. RAC certification is preferred; potential to work toward RAC certification if not current. Collaborate with clients and colleagues to improve policies and workflows while staying current with medical practice and regulatory changes.

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Government & Public Administration

Key Responsibilities

•Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules.
•Document all findings referencing the appropriate policies and rules.
•Generate letters articulating audit findings.
•Supporting your findings during the appeals process if requested.
•Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.

Key Requirements

•Active unrestricted RN license in good standing is required.
•Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting.
•One (1) or more years' experience performing medical records review.
•One (1) or more years' experience in health care claims that demonstrates expertise in ICD-9/ICD-10 coding, HCPCS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital.
•RAC certification preferred.

Experience:5+ yearsHealthcare

Skills:CommunicationAttention to detailRemote collaborationTime managementTeamwork

Tech Stack:Medical Coverage GuidelinesInterQualICD-9ICD-10CPTHCPCSDRGCase management system

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

4 weeks ago

Medical Review Nurse - CMS/RAC Auditor, Government Audits

✓ Verified Job

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

Source: Company careers pageValidated by: Fursa AI

Last checked: 7 hours agoStatus: Live

Job Summary

Location: United States

Workplace: Remote

Employment Type: Full time

Job Function: Government & Public Administration

Key Responsibilities

•Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules.
•Document all findings referencing the appropriate policies and rules.
•Generate letters articulating audit findings.
•Supporting your findings during the appeals process if requested.
•Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.

Key Requirements

•Active unrestricted RN license in good standing is required.
•Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting.
•One (1) or more years' experience performing medical records review.
•One (1) or more years' experience in health care claims that demonstrates expertise in ICD-9/ICD-10 coding, HCPCS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital.
•RAC certification preferred.

Experience:5+ yearsHealthcare

Skills:CommunicationAttention to detailRemote collaborationTime managementTeamwork

Tech Stack:Medical Coverage GuidelinesInterQualICD-9ICD-10CPTHCPCSDRGCase management system

Company Brief

Machinify

Industry: Industrial Automation

Website