Machinify

Machinify

Medical Review Nurse - Commercial DME Auditor

Remote - US

Sponsorship not specifiedDetected 12 hours ago
AuditingICD-10Communication

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odds of building a lasting career here

40Risky
Cap-exempt (no lottery)0
Sponsors this role90
Entry-level history0
PERM / green-card track0
Lottery odds40
Fits your clock70

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Employer immigration record

from this employer's Department of Labor filings

Files H-1B transfers

17 transfer filings in the last year, covering 17 workers. Median labor-condition decision: 7 days. An employer that already files transfers is one that can take over an existing H-1B.

Sourced from Department of Labor LCA, PERM and prevailing-wage disclosure data. Employer matching is by name, so figures may be split across an employer's legal entities. Absence of a filing means none appears in our copy of the data, not that none exists.

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About the role

  • Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country.
  • As a MR Nurse, you will join a team of experienced medical auditors and coders performing retrospective and prepayment audits on claims for Government and Commercial Payers.

Responsibilities

  • Document all findings referencing the appropriate policies and rules.
  • Ability to maintain high quality work while meeting strict deadlines.
  • Ability to manage multiple tasks including desk audits and claims review.

Requirements

  • Other duties as required to meet business needs.
  • Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings.
  • Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload

Nice to have

  • Active unrestricted RN license in good standing, is required.
  • Must not be currently sanctioned or excluded from the Medicare program by the OIG.
  • Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting.
  • Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.
  • Equal Employment Opportunity at Machinify
  • Machinify is an employment at will employer.
  • We participate in E-Verify as required by applicable law.
  • Required and Preferred Qualifications:

Skills

  • Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual.
  • Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding.
  • Knowledge of insurance programs program, particularly the coverage and payment rules.
  • Excellent written and verbal communication skills.

Compensation

  • In accordance with applicable state laws, we do not inquire about salary history during the recruitment process.

Benefits

  • We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
  • The Medical Review Nurse II - Commercial DME primarily performs medical claims audit reviews.
  • Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules.
  • Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits.
  • Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients.
  • Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines.
  • Interface with and support the Medical Director and cross train in all clinical departments/areas.
  • One (1) or more years' experience performing medical records review.

Company info

  • You will work remotely in a fast paced and dynamic environment and be part of a multi-location team.
  • We are proud to be an equal opportunity workplace.
  • If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know.

Visa & Work Authorization

  • al employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status
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This listing is sourced directly from Machinify's careers page and normalized into a canonical job model.