NCI Remote Medical Review RN - Part B/DME - Casual Status in Nashville, Tennessee

Remote Medical Review RN - Part B/DME - Casual Status

Posting Date:


Job Number:



Nashville, TN



Security Clearance Status:

Not Applicable

Security Clearance Type:


US Citizenship Required:


Job Level:

Individual Contributor

Employment Status:




NCI: As a Remote Medical Review RN - Part B/DME - Casual Status ( Medical Reviewer III ) supporting AdvanceMed, you will use your RN experience in Medicare medical review. You must be flexible with hours and have extensive knowledge of the Medicare Part B program, being able to apply the regulations and coverage guidelines for a variety of Part B services with an emphasis on DME. In assuming this position, you will be a critical contributor to meeting NCI AdvanceMed's mission: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse. Highlights of Responsibilities:

  • Review medical records in an electronic format and make a decision for Medicare coverage based on laws, regulations and coverage and payment criteria.

  • Must be familiar with the coding and billing as well as the coverage guidelines and criteria for Medicare Part B/ DME.


  • Minimum 3 years experience reviewing medical claims to determine medical necessity and appropriateness

  • Minimum of 5 years clinical experience

  • Graduate from an accredited nursing education program and has an active, current license as a Registered Nurse

  • Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program; and must have no conflict of interest (COI) as defined in 1154(b)(1) of the Social Security Act

  • At least 2 years utilization/quality assurance review and coding experience in ICD-9/10-CM, CPT, DRG, and payment methodologies (Correct Coding Initiative)

  • Advanced Knowledge of utilization review/ quality assurance procedures

  • Knowledge of, and the ability to correctly identify, Medicare coverage guidelines

  • Knowledge of and ability to use Microsoft Word, Excel and Internet applications at an intermediate level

  • Must have and maintain a valid driver's license for the associate's state of residence

Preferred Education and Experience:

  • Bachelors degree preferred but at a minimum have graduated from an accredited school of nursing

  • At least 2 years of work with Medicare medical review

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It is the policy of NCI to provide equal opportunity in recruiting, hiring, training, and promoting individuals in all job categories without regard to race, color, religion, national origin, gender, age, disability, genetic information, veteran status, sexual orientation, gender identity, or any other protected class or category as may be defined by federal, state, or local laws or regulations. In addition, we affirm that all compensation, benefits, company-sponsored training, educational assistance, social, and recreational programs are administered without regard to race, color, religion, national origin, gender, age, disability, genetic information, veteran status, sexual orientation, or gender identity. It is our firm intent to support equal employment opportunity and affirmative action in keeping with applicable federal, state, and local laws and regulations.

The information above has been designed to indicate the general nature and level of work performed by employees within the classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this position.