Senior Nurse Reviewer

About the role

The Senior Nurse Reviewer is responsible for coordinating, facilitating, and appealing clinical components of charge audits and forensic reviews. This position involves responding to the increased use of pre- and post-payer audits, impacting MGB net revenue.

Responsibilities

• Schedules audits with external third-party audit representatives/payors
• Prepares detailed audit packages and responses
• Defends audit findings through post-audit research
• Updates internal systems for tracking and reporting
• Provides subject matter expertise on billing, coding, and clinical topics

Requirements

• Bachelor's Degree in Nursing required
• Registered Nurse [RN - MA State License] - required
• 3+ years of clinical nursing experience
• 2+ years of experience in quality assurance or clinical review roles

Qualifications

• Strong appeal writing experience
• Strong analytical skills
• Excellent communication and interpersonal skills
• Proficiency in EHR systems and clinical documentation tools
• Strong organizational and attention to detail skills
• Ability to provide constructive feedback and facilitate training

Skills

• Appeal writing experience
• Analytical skills
• Communication and interpersonal skills
• EHR systems proficiency
• Organizational and attention to detail skills
• Constructive feedback provision

Benefits

Comprehensive benefits, career advancement opportunities, differentials, premiums, and bonuses as applicable, and recognition programs designed to celebrate contributions and support professional growth.

Pay

$79,560.00 - $115,720.80/Annual

Schedule

Remote, M-F eastern standard business hours. Requires a quiet, secure, HIPAA-compliant working station.