Medical Claims Reviewer - Remote

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider—we're your trusted partner in innovation. Are you a dedicated RN looking for a rewarding career in medical claims review? Broadway Ventures is seeking an experienced Registered Nurse (RN) to conduct pre- and post-payment medical reviews. This is an exciting opportunity to apply your clinical expertise in a non-traditional setting while making a meaningful impact on healthcare compliance and claim accuracy. About the Role: As a Medical Claims Reviewer, you will conduct medical reviews for Durable Medical Equipment (DME) claims. Using clinical expertise and established guidelines, you will assess claims, determine medical necessity, and document decisions. This role involves collaboration with providers and internal teams to ensure compliance and accuracy in claims processing. Position Details:

• Work Location:
• Remote: Work from home with high-speed (non-satellite) internet and a private home office.
• On-Site: Candidates living within driving distance of Nashville, TN will work in our Nashville office.
• Schedule: Monday – Friday, 8:00 AM to 5:00 PM CT
• Employment Type: Full-time (40 hours/week)

Key Responsibilities:

• Conduct medical claim reviews for complex services, pre-authorizations, appeals, fraud investigations, and coding accuracy.
• Use established clinical guidelines and protocol sets to make coverage and reimbursement determinations.
• Ensure claims meet contractor standards and comply with Medicare guidelines.
• Document medical rationale for claim approvals or denials.
• Provide education and support to internal/external teams regarding medical reviews, coverage determinations, and coding procedures.
• Participate in quality control activities and support LPN team members.
• Assist with special projects and additional responsibilities as assigned.

Qualifications – What You Need to Succeed: Required:

• Licensure: Active, unrestricted RN license in the U.S. (or active compact multistate RN license under the Nurse Licensure Compact - NLC).
• Education: Associate's degree in a related field OR graduate of an Accredited School of Nursing.
• Experience: Minimum two years of clinical nursing experience.

Skills:

• Ability to work independently, prioritize tasks, and make sound decisions.
• Strong analytical, critical thinking, and organizational skills.
• Proficiency in Microsoft Office and ability to work with multiple software programs.
• Confidentiality: Ability to handle sensitive information with discretion.

Preferred:

• Medicare Part B experience
• Medicare DME claims experience (strongly preferred)
• Intermediate computer proficiency with multitasking capabilities

Perks & Benefits:

• 401(k) with company match
• Dental insurance
• Medical insurance
• Life & Disability insurance
• Paid Time Off - the longer you stay, the more you earn!
• Paid Holidays

How to Apply: If you're a licensed RN looking for a remote opportunity in medical claims review, we'd love to hear from you! APPLY NOW to join Broadway Ventures and contribute to meaningful work in healthcare compliance and claims accuracy. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting. Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities. Apply tot his job Apply To this Job