Medical Reviewer, Registered Nurse

Remote

Full Time

Mid Level

This position is contingent upon the successful award of the associated contract. Employment is not guaranteed until the contract is awarded, and the position is officially activated. Job responsibilities and requirements are subject to change.

Medical Reviewer, Registered Nurse

About J29

At J29, we believe in empowering our employees to do great things for the benefit of others. Our culture is built on purpose, service, and impact — not just for our clients, but for our communities. We are a mission-driven, people-first organization that believes strong culture, thoughtful leadership, and meaningful philanthropy are inseparable from business success.

Key Responsibilities

RVC Reviewers perform both automated and complex reviews of Medicare Fee-for-Service (FFS) claims—including Part A/B, DMEPOS, and Home Health/Hospice—to assess overpayments, underpayments, and proper payments as determined by Recovery Audit Contractors (RACs). They apply Medicare policies and guidelines, ensuring claims are evaluated according to National and Local Coverage Determinations and CMS rules, and document clear, accurate findings for each claim.

Reviewers participate in dispute resolution by re-examining claims and providing supporting documentation, support quality assurance through audits and ongoing training, and maintain compliance with CMS security and privacy standards. They also collaborate closely with key personnel to ensure consistency, accuracy, and continuous process improvement in all review activities.

Qualifications

5+ years of direct medical coding or medical billing experience, specifically in a healthcare environment.

3+ years working in a productivity-based claims or case working environment, out of a queued case management system.

3+ years working remotely with various technology systems. Ideally, candidate will have 3+ years of Medicare Fee For Service (FFS) experience in a medical coding role or program.

Experience with low-code, no-code case management systems as an end-user is preferred but not required.

Education/Certification

Active license as a Registered Nurse, in good standing, in the United States (as verified by Nurses). Verified regularly.

Location: Remote (United States)
Salary: $70,000-85,000

J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.

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