Medical Reviewer (DME)

Are you a dedicated RN looking for a rewarding career in medical claims review? Broadway Ventures is seeking an experienced Registered Nurse (RN) to conduct pre- and post-payment medical reviews. This is an exciting opportunity to apply your clinical expertise in a non-traditional setting while making a meaningful impact on healthcare compliance and claim accuracy.

As a Medical Claims Reviewer, you will conduct medical reviews for Durable Medical Equipment (DME) claims. Using clinical expertise and established guidelines, you will assess claims, determine medical necessity, and document decisions. This role involves collaboration with providers and internal teams to ensure compliance and accuracy in claims processing.

• Work Location:
• Remote: Work from home with high-speed (non-satellite) internet and a private home office.
• On-Site: Candidates living within driving distance of Nashville, TN will work in our Nashville office.
• Schedule: Monday – Friday, 8:00 AM to 5:00 PM CT
• Employment Type: Full-time (40 hours/week)

• →Conduct medical claim reviews for complex services, pre-authorizations, appeals, fraud investigations, and coding accuracy.
• →Use established clinical guidelines and protocol sets to make coverage and reimbursement determinations.
• →Ensure claims meet contractor standards and comply with Medicare guidelines.
• →Document medical rationale for claim approvals or denials.
• →Provide education and support to internal/external teams regarding medical reviews, coverage determinations, and coding procedures.
• →Participate in quality control activities and support LPN team members.
• →Assist with special projects and additional responsibilities as assigned.

• Licensure: Active, unrestricted RN license in the U.S. (or active compact multistate RN license under the Nurse Licensure Compact - NLC).
• Education: Associate’s degree in a related field OR graduate of an Accredited School of Nursing.
• Experience: Minimum two years of clinical nursing experience.

• Ability to work independently, prioritize tasks, and make sound decisions.
• Strong analytical, critical thinking, and organizational skills.
• Proficiency in Microsoft Office and ability to work with multiple software programs.
• Confidentiality: Ability to handle sensitive information with discretion.

• Medicare Part B experience
• Medicare DME claims experience (strongly preferred)
• Intermediate computer proficiency with multitasking capabilities

If you're a licensed RN looking for a remote opportunity in medical claims review, we'd love to hear from you!

APPLY NOW to join Broadway Ventures and contribute to meaningful work in healthcare compliance and claims accuracy.

After submitting your application, our recruiting team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most qualified candidates. Broadway Ventures conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting.

Broadway Ventures is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, protected veteran status, or any other status protected by applicable law.

Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).