🩺 Remote Registered Nurse – Medical Review Specialist

📍 Location: Fully Remote (Must Reside in Bexar County, TX)
💼 Employment Type: Full-Time | No Weekends | No Holidays | No Travel
🏢 Company: Avosys Technology
🛡️ Industry: Federal/Defense | Medicare Claims
🆔 US Citizenship Required

👩‍⚕️ About the Role:

Avosys is seeking an experienced and detail-oriented Registered Nurse (RN) to serve as a Medical Review Specialist for Medicare Part A and Part B claims. This is a fully remote role, allowing you to work from the comfort of your home in Bexar County, Texas, while making a real difference in ensuring compliance, accuracy, and fairness in Medicare claim decisions.

🏥 Key Responsibilities:

Conduct clinical reviews of Medicare claims (pre-payment, post-payment, appeals, and prior authorizations)
Analyze medical documentation and assess medical necessity based on CMS guidelines and the Social Security Act
Utilize Medicare policies, National/Local Coverage Determinations, and IOMs to validate claim compliance
Prepare and document well-written, educational justifications for claim approvals, reductions, or denials
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Submit sample claims for internal quality checks and finalize decisions based on feedback
Collaborate with providers via phone, webinars, or calls to provide educational guidance and claim support
Track and record all case activities in internal systems, ensuring timely documentation and follow-up
Refer suspected fraud cases and submit outreach requests for high-error claims
Participate in training sessions, team meetings, and internal quality assurance reviews

📌 Requirements:

✅ Qualifications:

Current and active RN license
Minimum of 2 years of direct clinical experience
Exceptional written and verbal communication skills
Proficiency with Microsoft Office and electronic medical record systems
Prior experience in Medicare claims review, case management, or utilization review is a plus

🛡️ Additional Requirements:

Must be a U.S. Citizen
Must reside in Bexar County, Texas
Must pass a background check
No current security clearance required

🎁 What Avosys Offers:

🏡 100% Remote Work – Enjoy work-life balance without commuting
⏱️ Guaranteed 8-hour shifts – No overtime, no weekends, no holidays, no on-call hours
💰 Competitive Benefits Package including:
- Medical, dental, and vision insurance
- Life insurance
- Short- and long-term disability
- 401(k) retirement savings plan

🤝 About Avosys Technology:

Founded in 1998, Avosys is a fast-growing provider of professional, technological, and management solutions serving Federal, State, and Commercial clients nationwide. Our success is built on the strength and dedication of our people, and we believe in hiring the best to lead the way.

🌈 Equal Opportunity Employer:

Avosys is proud to be an Equal Opportunity Employer. We are committed to building a diverse and inclusive workplace. All qualified applicants will receive consideration for employment without discrimination based on race, religion, gender identity, disability, or veteran status.

If you require a reasonable accommodation during the application process, please contact us directly for assistance.

📩 Apply Now to join Avosys and make a meaningful impact in healthcare compliance from your home in Bexar County!

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