Job Title: Registered Nurse – Medical Claims Reviewer (FES Claims)
Location: Remote (occasional onsite training may be required)
Duration: 13 Weeks
Shift: Mon–Fri, 8:00 AM – 5:00 PM | No weekends
Pay Type: Contract
Overview:
Seeking an experienced RN to review and adjudicate FES 1500 emergency medical claims. This remote role requires strong clinical judgment, familiarity with claims processing, and compliance knowledge. Candidates must be self-directed and detail-oriented.
Responsibilities:
Review emergency medical claims for accuracy, coding, and medical necessity
Apply InterQual criteria, CCI edits, and relevant regulations (AHCCCS, CMS)
Collaborate on second-level reviews and special projects
Analyze data for trends, reporting, and cost savings
Requirements:
Active RN license (Arizona)
BLS certification
Arizona Fingerprint Clearance Card (prior to start)
Proficiency in CPT, HCPCS, ICD-9/10
Knowledge of managed care, InterQual, and claim adjudication
Tech Requirement:
Personal laptop (remote access provided)
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