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Remote Registered Nurse – Medical Claims Review (FES 1500) Job Available in Phoenix Arizona

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Job Details

Remote Registered Nurse – Medical Claims Review (FES 1500)

Location: Remote (AHCCCS provides computer and remote desktop access)
Schedule: Monday–Friday | 8:00 AM – 5:00 PM | 40 hrs/week, no OT guaranteed

Position Overview

Work remotely to review and adjudicate Federal Emergency Services (FES) 1500 claim forms. Evaluate claims for emergency criteria, medical necessity, coding accuracy, and appropriateness of care. Coordinate with medical providers and internal teams as needed.

Key Responsibilities

  • Review claims using industry standards and AHCCCS guidelines.

  • Evaluate medical documentation for emergency criteria, correct coding (CPT, HCPCS, ICD-9), level of care, and length of stay.

  • Prepare reports, analyze trends, and perform special projects.

  • Maintain accurate records and data for reporting purposes.

  • Collaborate with providers and internal teams; work independently with minimal supervision.

Knowledge & Skills

  • Medical nursing practices and case management protocols across populations (Maternal/Child Health, EPSDT, LTC, behavioral/mental health, Tribal).

  • Managed care processes, acute nursing assessment, InterQual Criteria, CCI.

  • Medical claims review, statistical analysis, and data management.

  • Strong written/oral communication, organizational, and research skills.

  • Proficient in computer systems and remote work platforms.

Requirements

  • Active Arizona RN License

  • Behavioral health experience, preferably outpatient

  • Fingerprint Clearance Card (or ability to obtain)

  • High school diploma; healthcare experience required

Preferred

  • Experience in concurrent/retrospective review, InterQual, CCI, CPT/HCPCS coding, managed care review

  • CPT coding certification a plus

Qualifications

  • Must be at least 18 years of age
  • Strong customer service and communication skills required
  • Ability to work a flexible work schedule including nights, weekends and holidays
  • Ability to lift, carry, push, and pull a minimum of 50 pounds required
  • Ability to unload freight, to move product on and off of store shelves, to walk, stand, bend, stoop, or kneel for long periods of time, and to move freely throughout store on a continual basis required
  • Basic English literacy and math skills required
  • We will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws
  • full-time
  • No Degree mentioned

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