• Central: 8:00 AM – 4:30 PM CT
• Eastern: 9:00 AM – 5:30 PM ET

Position Summary

Key Responsibilities

• Review and analyze complex medical bills, including multi-procedure surgical cases and diagnostic services
• Evaluate documentation such as operative reports and medical charts to ensure billing accuracy
• Compare assigned CPT and ICD codes against clinical documentation to verify appropriate coding
• Apply state-specific fee schedules and reimbursement policies to determine accurate payment outcomes
• Conduct bill re-evaluations and provide clear, compliant rationale for approvals or denials
• Collaborate with bill review specialists, nurses, and internal stakeholders to resolve complex cases
• Maintain high levels of accuracy and consistency while meeting productivity expectations
• Document findings and decisions clearly within internal systems

Qualifications

• Active, unrestricted LPN, LVN, or RN license in the state of residence (compact license not required)
• 2–3 years of clinical nursing experience
• Strong computer proficiency, including the ability to navigate complex systems and data-heavy platforms
• Demonstrated ability to quickly learn and apply medical coding concepts (CPT and ICD)
• High attention to detail with strong analytical and problem-solving skills
• Excellent written and verbal communication skills

What Makes This Role Challenging

• Learning medical coding: This role requires nurses to develop proficiency in CPT and ICD coding, which is not typically part of standard clinical practice
• Technical complexity: The bill review platform is highly detailed and requires strong digital fluency, similar to working in complex spreadsheet environments
• Productivity expectations: Once fully ramped, reviewers are expected to process approximately 40 bills per day while maintaining strict accuracy standards
• Extended onboarding period:
  • 6–8 weeks of structured training
  • 6–8 weeks of quality control (QC) review
  • Total ramp-up of 3–6 months before independent production