Top 77 Cms diagnostic Jobs in Remote

Clinical Reviewer (Part-time)
Neil Hoosier & Associates, Inc. —Remote
- $40 - $45 an hour
- Part-time
- Microsoft Excel
- Microsoft Outlook
- RN License
Quick Apply
Profee Surgical Auditor
LexiCode —Remote
- $28 - $35 an hour
- Full-time
- Remote
- Surgery
- HIPAA
- Mid-level
Quick Apply
Certified Coding Specialist I (Temporary)
NeoGenomics Laboratories —Remote
- Temporary
- Remote
- Anatomy knowledge
- HIPAA
- Medical terminology
Quick Apply
1d
MEDICARE POLICY ANALYST
Solventum —Remote
- $96,000 - $132,000 a year
- Full-time
- Remote
- RN License
- Mid-level
- Microsoft Office
- Health savings account
- Disability insurance
Professional Fee Coder II (Remote)
Stanford Health Care —Sacramento, CA
- $52.37 - $58.98 an hour
- Full-time
- Remote
- Anatomy knowledge
- Surgery
- Mid-level
Professional Coder - Per Diem - Day - Physician Professional Coders Remote
Capital Health —Remote
- $25.49 - $33.16 an hour
- 8 hour shift
- Remote
- Microsoft Word
- Anatomy knowledge
- Microsoft Excel
- Disability insurance
- Health insurance
8d
Hospital Emergency Department - Medical Coder- Remote
Valerion Health —Remote
- Full-time
- Remote
- Anatomy knowledge
- Mid-level
- 3 years
Quick Apply
14d
Remote Registered Nurse
US Heart & Vascular —Dallas, TX
- Full-time
- Remote
- Nursing
- RN License
- BLS Certification
Medical Director - Psychiatrist (Women's Health)
Precise Behavioral INC. —California
- $250,000 - $350,000 a year
- Full-time
- Remote
- Background check
- Medicine
- Psychiatry
- Health insurance
- Dental insurance
Quick Apply
Women's Psychiatric Mental Health Nurse Practitioner - Idaho
Delia Health —Remote
- $130 an hour
- Contract
- Remote
- LMFT
- Nursing
- Doctoral degree
- Flexible schedule
Quick Apply
2d
Professional Coder - FT - Day - Physician Professional Coders Remote (NJ, PA, AL)
Capital Health —Remote
- $25.49 - $33.16 an hour
- 8 hour shift
- Remote
- Microsoft Word
- Anatomy knowledge
- Microsoft Excel
- AD&D insurance
- Disability insurance
Outpatient Medical Coder- Full Time
Sierra7 —Remote
- Full-time
- Anatomy knowledge
- HIPAA
- Mid-level
- Health savings account
- Disability insurance
2d
Inpatient Coder
Jzanus Consulting —Remote
- From $50,000 a year
- Full-time
- Remote
- 5 years
- Analysis skills
- Computer skills
Medical Coder III
Decypher —Remote
- Up to $40.09 an hour
- Full-time
- Remote
- 1 year
- Senior level
- Radiology
Quick Apply
13d
Coder II - Outpatient - Coding & Reimbursement Srvc
Lakeland Regional Health —Remote
- $19.37 - $24.22 an hour
- Remote
- Background check
- Anatomy knowledge
- Clinic experience
- Flexible schedule
Quick Apply
Nurse Educator & Quality Assurance Specialist (Contractor)
Everlywell —Remote
- Contract
- Remote
- Google Workspace
- RN License
- 5 years
Medical Coder - Risk Adjustment Specialist
Volunteers of America, Inc. —Eden Prairie, MN
- $58,000 - $66,000 a year
- Monday to Friday
- Remote
- Anatomy knowledge
- 5 years
- Writing skills
Quick Apply
Remote Web Developer & Digital Analytics Specialist
Datamark, Inc. —El Paso, TX
- $65,000 - $75,000 a year
- Full-time
- Remote
- Computer Science
- Mid-level
- 3 years
- AD&D insurance
- Paid holidays
Quick Apply
Family Medicine Coder (Coding Specialist 2)
Oregon Health & Science University —Portland, OR
- $33.07 - $44.69 an hour
- Full-time
- Remote
- Anatomy knowledge
- Word processing
- Mid-level
- Paid holidays
- Health insurance
Principal, Evidence & Strategy (RWE/Analytics)
Avalere Health —Remote
- $195,000 - $225,000 a year
- Full-time
- Hybrid work
- Writing skills
- Bachelor's degree
- Experience equivalent to degree accepted
- Disability insurance
- Health insurance
Quick Apply

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Clinical Reviewer (Part-time)

Neil Hoosier & Associates, Inc. -
Remote

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Job Details

Part-time
$40 - $45 an hour

Qualifications

Microsoft Excel
Microsoft Outlook
Medicare
RN License
Medicare coding guidelines
5 years
Medical Coding Certification
Writing skills
CMS
CMS regulatory compliance
Quality assurance
Case review audits
Pre-authorization review for utilization management
Medicare regulations
Nurse Practitioner (NP)
Task prioritization
Quality control
Policy verification in claims processing
Clinical documentation
Microsoft Teams
SharePoint
Centers for Medicare & Medicaid Services (CMS) billing regulations
Data accuracy checks
Senior level
Clinical documentation standards
Communication skills
Medical record review for billing accuracy
Documentation reviews

Full Job Description

Pay Range: $40 - $45 per hour based on experience
Work Hours: 20 hours per week (Mon - Fri)
Location: Remote

Summary:
The Clinical Reviewer is responsible for conducting clinical reviews of submitted prior authorization (PA) requests and pre-payment requests submitted to Fee-For-Service Medicare by Providers and/or Suppliers. The reviewer verifies that each request includes accurate, complete clinical documentation and meets all applicable Medicare coverage, coding, and payment rules, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). This role ensures that determinations are evidence-based, compliant, and aligned with the CMS requirements.

Responsibilities and Duties:

Review submitted prior authorization requests and/or pre-payment requests to determine whether required documentation is complete, accurate, and compliant with Medicare criteria.
Evaluate medical necessity based on relevant NCDs, LCDs, and Local Coverage Articles as required for each item and/or service assessing clinical evidence provided.
Provide clinical justification for affirmation or non-affirmation of accuracy decision
Ensure all determinations align with Medicare requirements and CMS model rules
Maintain thorough, organized documentation of clinical assessments, rationale, and determinations.
Support quality reviews to ensure consistency and accuracy across determinations.
Assist with writing review protocols, procedures, workflows, etc
Attend required meetings and workgroups as needed to perform independent case reviews (e.g., procedural changes, sharing trends, reviewing information on specific case files, and discussing issues or questions)
Meet productivity and quality assurance standards
Work in Project Manager to determine reviewer workload, tasking, and priorities

Qualifications:

Licensed clinician (e.g., MD/DO, PA, NP, RN)
At least 5 years of professional healthcare experience
Working knowledge and understanding of Medicare coverage guidelines and clinical expertise to evaluate the medical necessity determination
Medical Coding Certification (ICD-9-CM, ICD-10-CM, CPT-4 and HCPCS) preferred
Ability to interpret clinical records, imaging, diagnostic tests, and practitioner notes.
Familiarity with CMS prior authorization programs, MAC processes, or pre-payment medical review, preferred
Excellent clinical judgement and critical thinking.
Strong written and oral communication skills for documenting and communicating determinations.
Ability to work in a structured, time-sensitive environment.
High attention to detail and accuracy.
Proficiency with Microsoft Office Suite such as Outlook, Word, Teams, and Excel, and SharePoint
Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
Must have no conflict of interest (COI) as defined in Section 1154(b)(1) of the Social Security Act (SSA)

NHA is a state and federal government contractor; all employees must be legally authorized to work in the United States. NHA does not provide sponsorship at this time.

NHA is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment based on merit, without regard to race, color, religion, sex, sexual orientation, national origin, veteran status, disability or any other basis protected by law.

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Refine Your Search

cms diagnostic jobs in remote

Clinical Reviewer (Part-time)

Profee Surgical Auditor

Certified Coding Specialist I (Temporary)

MEDICARE POLICY ANALYST

Professional Fee Coder II (Remote)

Professional Coder - Per Diem - Day - Physician Professional Coders Remote

Hospital Emergency Department - Medical Coder- Remote

Remote Registered Nurse

Medical Director - Psychiatrist (Women's Health)

Women's Psychiatric Mental Health Nurse Practitioner - Idaho

Professional Coder - FT - Day - Physician Professional Coders Remote (NJ, PA, AL)

Outpatient Medical Coder- Full Time

Inpatient Coder

Medical Coder III

Coder II - Outpatient - Coding & Reimbursement Srvc

Nurse Educator & Quality Assurance Specialist (Contractor)

Medical Coder - Risk Adjustment Specialist

Remote Web Developer & Digital Analytics Specialist

Family Medicine Coder (Coding Specialist 2)

Principal, Evidence & Strategy (RWE/Analytics)

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