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Nurse Reviewer, RN
FHAS, LLCNurse Reviewer RN providing timely review and determination of medical claims for a healthcare provider. Analyzing records and adjudicating claims based on federal regulations and policies.
Posted 7/17/2026full-timeRemote • Pennsylvania • 🇺🇸 United StatesJunior💰 $67,500 - $95,000 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical claims review, including prior authorization and appeals, while applying Medicare regulations and coding guidelines. Proficient in analytical skills and effective communication to support findings and collaborate with team members.
Highest-signal resume keywords
Clinical ExperienceProfessional Coding CertificationKnowledge of Medicare RegulationsCPT, HCPCS, ICD-10 CodingAnalytical Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Claims ReviewPrior AuthorizationAppeals ProcessingMedical Record AnalysisRegulatory Citation ApplicationClaim AdjudicationCPT CodingHCPCS CodingICD-10 CodingMedicare Billing Irregularities
Soft Skills
Analytical SkillsWritten CommunicationOral CommunicationOrganizational SkillsTeam Player
Tools & Technologies
PCRelated Software Programs
Certifications & Qualifications
Registered Nurse (RN)Professional Coding Certification
Industry Keywords
Local Coverage Determination (LCD)National Coverage Determination (NCD)Federal RegulationsPayor ReimbursementsIRR Surveys
About the role
Key responsibilities & impact- Provide timely review and determination of medical claims, including prior authorization, appeals, and/or any other type of medical claims;
- Analyze medical records related to the case file;
- Review and interpret Local Coverage Determination (LCD), National Coverage Determination (NCD) policies, and other federal regulations;
- Apply appropriate regulatory citations, including health plan policies, NCD/LCDs, and/or other regulations to each claim as it relates to the item or issue;
- Formulate a narrative decision citing relevant regulatory back-up documentation contained within the medical record;
- Adjudicate claim based on the regulations and documentation contained within the medical record;
- Attend FHAS and/or client Lunch & Learn sessions and/or general training sessions on site as needed.
- Complete IRR surveys in a timely fashion as required by the prime contractor Maintain a 97% or higher quality score work experience requirements
Requirements
What you’ll need- 1+ years clinical experience required; coding, utilization, and/or medical chart review preferred.
- Professional Coding Certification preferred.
- Detailed knowledge of Medicare regulations and guidelines, polices, and payor reimbursements preferred.
- Knowledge of CPT, HCPCS, ICD-10 codes and coding guidelines.
- Ability to identify Medicare billing and payment irregularities.
- Must be able to support review findings by utilizing exceptional analytical, written and oral communication skills.
- Ethical, self-motivated and results oriented team player.
- Strong analytical, verbal and written communication skills.
- Outstanding people skills and ability to effectively review findings /results with management.
- Must be proficient with PC and related software programs.
- Excellent organizational skills.
- Must be a team player.
- Must possess a current, unrestricted State license as a Registered Nurse (RN),as required by contract(s).
Benefits
Comp & perks- 🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account FHAS, LLC Website LinkedIn All Job Openings 51 - 200 employees Founded 1996 ⚕️ Healthcare Insurance 🏛️ Government 🤝 B2B Healthcare Insurance
- Government
- B2B FHAS, LLC is a provider of data-driven medical review, appeals management, independent dispute resolution (IDR), and hearings/adjudication services for health plans, federal and state agencies, and government contractors. The company combines accredited clinical and legal expertise with AI-augmented, cloud-based platforms to deliver scalable, compliant reviews, claims adjudication, provider education, and dispute resolution that reduce improper payments, improve regulatory compliance, and accelerate case outcomes. Nurse Reviewer, RN Job not on LinkedIn 🔥 2 hours ago 🔔 Pennsylvania – Remote 💵 $67.5k - $95k / year ⏰ Full Time 🟢 Junior ✨ Reviewer Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
- Provide timely review and determination of medical claims, including prior authorization, appeals, and/or any other type of medical claims;
- Analyze medical records related to the case file;
- Review and interpret Local Coverage Determination (LCD), National Coverage Determination (NCD) policies, and other federal regulations;
- Apply appropriate regulatory citations, including health plan policies, NCD/LCDs, and/or other regulations to each claim as it relates to the item or issue;
- Formulate a narrative decision citing relevant regulatory back-up documentation contained within the medical record;
- Adjudicate claim based on the regulations and documentation contained within the medical record;
- Attend FHAS and/or client Lunch & Learn sessions and/or general training sessions on site as needed.
- Complete IRR surveys in a timely fashion as required by the prime contractor Maintain a 97% or higher quality score work experience requirements 🎯 Requirements
- 1+ years clinical experience required; coding, utilization, and/or medical chart review preferred.
- Professional Coding Certification preferred.
- Detailed knowledge of Medicare regulations and guidelines, polices, and payor reimbursements preferred.
- Knowledge of CPT, HCPCS, ICD-10 codes and coding guidelines.
- Ability to identify Medicare billing and payment irregularities.
- Must be able to support review findings by utilizing exceptional analytical, written and oral communication skills.
- Ethical, self-motivated and results oriented team player.
- Strong analytical, verbal and written communication skills.
- Outstanding people skills and ability to effectively review findings /results with management.
- Must be proficient with PC and related software programs.
- Excellent organizational skills.
- Must be a team player.
- Must possess a current, unrestricted State license as a Registered Nurse (RN),as required by contract(s). Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Oasis Reviewer 🕒 July 1 Pennant 1001 - 5000 Website LinkedIn All Job Openings OASIS Reviewer ensuring compliance and data integrity for Home Health documentation. Collaborating with clinicians and reviewing assessments for accuracy and completeness. 🇺🇸 United States – Remote 💰 $108.5M Post-IPO Equity - The Pennant Group on 2024-10 ⏰ Full Time 🟢 Junior 🟡 Mid-level ✨ Reviewer DRG Reviewer 🕒 June 29 Machinify 1001 - 5000 ⚕️ Healthcare Insurance 🤖 Artificial Intelligence ☁️ SaaS Website LinkedIn All Job Openings DRG Reviewer at Machinify conducting thorough DRG payment validation reviews including medical record assessments. Collaborating with stakeholders to ensure compliance and support accurate payment determinations. 🇺🇸 United States – Remote 💵 $90k - $115k / year 💰 $10M Series A - Machinify on 2018-10 ⏰ Full Time 🟢 Junior 🟡 Mid-level ✨ Reviewer 🦅 H1B Visa Sponsor Pre-Underwrite Reviewer 🕒 June 29 NightOwl Consulting 51 - 200 🤝 B2B 🎯 Recruiter ☁️ SaaS Website LinkedIn All Job Openings Pre-Underwrite Reviewer assisting the team to ensure a happy home-buying experience. Providing underwriting support and reviewing borrower documentation for accuracy. 🇺🇸 United States – Remote 💵 ₱50k - ₱75k / month ⏰ Full Time 🟢 Junior 🟡 Mid-level ✨ Reviewer Oasis Reviewer 🕒 May 31 Pennant 1001 - 5000 Website LinkedIn All Job Openings OASIS Reviewer responsible for analyzing OASIS documentation accuracy and compliance. Collaborating with clinical staff in healthcare service based in Texas. 🇺🇸 United States – Remote 💰 $108.5M Post-IPO Equity - The Pennant Group on 2024-10 ⏰ Full Time 🟢 Junior 🟡 Mid-level ✨ Reviewer Experienced Case Reviewer 🕒 May 26 CACI International Inc 10,000+ employees 🔒 Cybersecurity Website LinkedIn All Job Openings Reviewer for DHS conducting quality reviews of background investigations ensuring compliance and accuracy. Collaborating with investigators and offering guidance on investigation requirements. 🇺🇸 United States – Remote 💵 $54.8k - $115k / year ⏰ Full Time 🟢 Junior ✨ Reviewer 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs