This role focuses on remote clinical review of coded medical records, validating coding accuracy and supporting documentation integrity. The work is centered on chart review rather than direct patient care, with attention to medical necessity, coding rules, and consistency across claims and records. It is well suited to an RN who is comfortable working independently in a tech-enabled, nonclinical review setting.
Key Responsibilities
- Conduct retrospective review of medical records and coded claims for accuracy and completeness.
- Validate clinical documentation against coding and billing guidelines.
- Identify coding discrepancies, missing documentation, and potential compliance issues.
- Coordinate findings with internal teams to support coding integrity and quality review workflows.
- Use electronic systems and documentation tools to complete remote chart reviews.
Required
- Current Registered Nurse (RN) license.
- Experience with clinical documentation review, coding review, or related utilization/quality functions.
- Familiarity with medical coding and health record documentation standards.