Medical Reviewer, RN

Medical Reviewer, RN

About J29

J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as an employee-centered healthcare management consulting company. Our team of 260 employees focuses on providing processing, review, and analysis of medical claims, records, data, and audits between areas of compliance, policy, and clinical expertise. Our team is experienced in program, payment, provider, and patient integrity as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the commercial, State, and Federal levels.

J29 was founded to be an employee-centric company that prioritizes the well-being and value of its employees. Our mission is to empower our employees to do great things for the benefit of those that need it most. The J29 mission supports not only our health and human service programs, but also the philanthropy efforts of our team. We are proud to continue our support to non-profit groups with critical missions as J29 continues to grow.

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.

• Active Medical Coding Certification (CPC, CCS or equivalent) required

• 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.

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.

Originally posted on Himalayas