Medical Reviewer – 1099 Contract

Job not on LinkedIn

🕒 September 28

🇺🇸 United States – Remote

💵 $28 - $31 / hour

⏳ Contract/Temporary

🟢 Junior

🟡 Mid-level

🔍🏥 Medical Reviewer

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Open for 46 days.
• Jobs at this company usually fill in 46 days.

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Simsy Ventures

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2022

💼 Consulting

📣 Marketing

🏥 Healthcare

Consulting • Marketing • Healthcare

Simsy Ventures is a venture builder and institutional co-founder that partners with entrepreneurs, investors, and corporations to create sustainable startups. Their mission focuses on enabling startups to achieve true potential while promoting a positive impact on profits, people, and the planet. With a structured approach, they support startups throughout their lifecycle, from ideation to market validation and growth. By leveraging a repeatable venture studio model, Simsy Ventures aims to uplift economies globally through impactful entrepreneurship.

📋 Description

• Conduct comprehensive reviews of home health pre-claim review (PCR) packages to determine compliance with Medicare coverage, coding, and payment criteria • Document affirmation/non-affirmation outcomes with well-defined clinical rationale in the designated case management system within 7 business days • Engage with providers, as authorized, to request or clarify documentation • Escalate provider concerns or suspected fraud in accordance with established program procedures • Maintain 98% accuracy • Complete required training, quality assurance reviews, and inter-rater reliability sessions

🎯 Requirements

• All RN Medical Reviewers must possess an active, unrestricted RN license in their state of residence • A minimum of 2 years of clinical experience • At least 2 years of experience in home health, quality assurance, or utilization review • Experience in home health (OASIS, Medicare Conditions of Participation) or prior involvement with MAC/RCD/CMS program integrity (preferred) • Proficiency in ICD coding (preferred) • Must complete background checks and drug testing prior to the start of employment • Some positions may require fingerprinting

🏖️ Benefits

• 401(k) and company match • PTO that grows the longer you stay • Health, Vision, Dental • Company provided Life Insurance and Voluntary Life Insurance • Short Term Disability and Long Term Disability

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