Medical Reviewer (DME)

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.

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. About the Role: 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. Position Details: 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.