STAR Medical Auditing Services is a boutique consulting firm that provides Health Information Management (HIM) and Clinical services to various organizations in the healthcare ecosystem across the U.S. We pride ourselves in providing high-quality services that are tailored to our clients' specific needs, while creating joyful experiences along the way by treating everyone with respect and care.
Must reside and be legal to work in the U.S.
About the Role
- Contract: 6 months with benefits (August - December 2026)
- Location: Fully Remote
- Schedule: Monday-Friday, 8am-4:30pm CST (No weekends, No holidays)
We are hiring experienced Registered Nurses as Clinical Reviewers. In this fully remote role, you will conduct medical record reviews for Medicare Part A and Part B claims to ensure compliance with CMS regulations, coverage policies, and standards of care.
Using Medicare guidelines and analytical skills, you will evaluate documentation for medical necessity, identify potential improper payments, and ensure accurate billing practices. You will document clear, defensible review determinations and communicate findings to providers and stakeholders as required.
Must be computer savvy and able to navigate multiple screens and windows.
Key Responsibilities
- Perform complex medical reviews of provider claims and documentation to determine if services provided meet Medicare coverage, coding, and medical necessity requirements.
- Assist in executing nationwide medical review projects as directed by CMS, focusing on specific vulnerabilities identified through data analysis.
- Participate in education sessions by phone and Microsoft Teams.
- Apply expert knowledge of National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and the CMS Internet-Only Manuals (IOMs).
- Maintain high-level accuracy (98%+) while meeting daily production quotas in a fast-paced, structured environment.
- Collaborate and communicate with peers and leaders.
- Participate in team quality and calibration review processes.
Minimum Qualifications
- Associate's or Bachelor's degree in Nursing (BSN preferred)
- Current, active, and unrestricted Registered Nurse (RN) license in your state of practice
- Minimum of 3-5 years of relevant clinical experience
- Minimum 1 year of Medicare claims review, Medical Audit, or Clinical documentation review experience required
- Strong verbal and written communication skills
- Previous remote work experience
- Strong computer experience and proficiency (Must be able to navigate multiple software platforms: Microsoft Teams, SharePoint, and internal CMS databases)
- Excellent critical thinking skills to interpret notes, imaging, and diagnostic tests against complex federal regulations
- Ability to work independently, meet deadlines, and work under pressure while maintaining a positive attitude
Work Environment
- Hardwired Internet Connection required
- Ability to sit at a computer terminal for an extended period
- Moderate noise (i.e., phone calls, online meetings, computer audio)
Benefits
- 401(k)
- Dental, Vision, and Health insurance
- Flexible spending account (FSA) and Health savings account (HSA)
- Life and Disability insurance
- Paid time off
- Parental leave
- Professional development assistance
- Referral program
Pay
- $35.00 - $40.00 per hour