Medical Review Nurse - Home Health Auditor
Himalayas · 4 दिन पहले
जॉब विवरण
ABOUT MACHINIFY: In October 2025, Machinify acquired Performant and we are now part of the Machinify organization
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans
Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy
We’re reshaping healthcare payment through seamless intelligence
ABOUT THE OPPORTUNITY: Hiring Range: $78,500 - 90,000 The Medical Review Nurse - Home Health primarily performs medical claims audit reviews on Home Health claims
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
You will work remotely in a fast paced and dynamic environment and be part of a multi-location team
Key Responsibilities: Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules
Document all findings referencing the appropriate policies and rules
Generate letters articulating audit findings
Supporting your findings during the appeals process if requested
Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse
