Position: Dispute Resolution Reviewer (100% Remote)- LPN/ LVN Position Overview: We are seeking a detail-oriented and analytical Dispute Resolution Reviewer to join our team in a fully remote capacity. In this role, you will provide patients, beneficiaries, and providers the opportunity to submit documentation supporting appeals or disputes. You will be responsible for making independent, second-level determinations based on medical records, applicable laws, regulations, and established guidelines. Key Responsibilities: • Review medical records and case files to evaluate appeals and disputes • Write clear, concise, and impartial reconsideration and dispute resolution decisions • Make sound, independent determinations based on medical evidence and regulatory guidelines • Ensure all issues raised by patients, representatives, and providers are fully addressed • Conduct research using federal regulations, medical literature, and policy resources • Stay up to date with changes in healthcare regulations, policies, and best practices • Maintain thorough and accurate documentation of all reviews and decisions Contract Details: • Start Date: Within 2 weeks • Schedule: Monday–Friday • Core hours: 9:00 AM – 3:00 PM EST • Additional 2 hours/day flexible (before 9 AM or after 3 PM) • Total: 40 hours/week • Overtime opportunities available • Training: • Duration: 6 weeks (paid, fully online) • Schedule: Monday–Friday, 8:30 AM – 4:00 PM EST Compensation: • $31.25 per hour Benefits: • Medical, dental, and vision insurance • Paid holidays Job Types: Full-time, Contract Pay: $31.25 per hour Benefits: • Dental insurance • Health insurance • Life insurance • Vision insurance Education: • Associate (Preferred) Experience: • Medicare appeals : 3 years (Preferred) • medical review: 3 years (Preferred) • healthcare: 3 years (Preferred) Work Location: Remote
A healthcare organization offering remote clinical review and dispute/appeals services, hiring licensed nurses for medical record review and regulatory-based determinations.
