Medical Review Nurse II - SNF/MDS
Remote • United States
- Full Time
- $84,000 – $100,000/year
- Min. 5 YOE
Last updated April 5, 2026 at 10:08 PM UTC
Medical Review Clinical Appeals Auditor (RN) responsible for conducting Appeals reviews of new evidence, documenting results, and contributing to continuous improvement within medical review and audit processes.
Healthcare Audit Recovery Analyst position performing Medicare/Medicaid claim audit reviews and related duties.
The HCS Operations Inventory & Quality Analyst (Eligibility) leverages strong knowledge of healthcare eligibility, healthcare claims, eligibility validation practices, Coordination of Benefits and Third-Party Liability (COB/TPL), or Medicare Secondary Payer (MSP), plus strong data analysis and technical skills to support inventory management, process documentation, and production QA process for assigned operations teams in the Eligibility organization.
The HCS Operations Support Services team performs activities to healthcare audit client inventory activities such as claim re-pricing, client inventory status reporting, responding to client inquiries, researches and resolves issues that may arise, and other client account ad-hoc reporting and inventory support activities. This Lead position serves as the team’s first point of escalation for Operations Support Representatives and Analysts, performs coordination and follow-up on regular operational inventory activities within Operations Support as well as broader audit team, supports assigning team resources for ad-hoc reports and requests, supports team training for new team members, performs team quality assurance reviews, and other duties in support of the team and management to provide excellent services to our healthcare clients.
As a Healthcare Customer Service Specialist II (SCA) you will work within a team and be the primary point of contact for all providers, Medicare contractors, etc. This position provides professional, accurate and timely responses to CMS (Medicare) and provider inquiries.