Medical Claims Review Nurse Salary in United States

To get your salary data, use the search bar below or browse by job, city, or state.
loading...

Job title is required

loading...

Job location is required.

Average Salary for Medical Claims Review Nurse in United States

The average salary of a(n) Medical Claims Review Nurse in United States is $76,039.

The average hourly rate of a(n) Medical Claims Review Nurse in United States is $36.56.

The average bonus of a(n) Medical Claims Review Nurse in United States is $1,239.00.

Job Description:

Resolves, audits, and processes claims for clinically related issues to ensure accuracy of claims payment, supporting the Claims Administration Department. Maintains contact with community hospitals and providers, reviewing, processing, and auditing claims for payment and appropriateness of charges and pursues adjustments as warranted. Typically requires licensure as a Registered Nurse and at least one year of experience in utilization review or a managed care setting. Screens, audits, and processes claims of specific criteria for appropriate payment. Establishes effective ongoing relationships with community hospitals and providers. Participates in educational, provider relations, and contracting meetings with providers to address medical claims payment issues. Visits the providers as necessary to compare billed charges to the medical record. Provides support to the Accounting Department in determining financial liability for out-of-plan medical services. Performs special projects, reconciliations, research, and analysis relating to the utilization and cost of medical services. Works closely with various departments to coordinate the flow of information involving payment of medical bills and analyses of financial liability. Ensures compliance with contractual obligations on claims payments. Documents findings and writes follow-up reports. Recommends and implements innovative strategies to retain members, contain medical costs, and improve efficiency. Less

Resolves, audits, and processes claims for clinically related issues to ensure accuracy of claims payment, supporting the Claims Administration Department. Maintains contact with community hospitals and providers, reviewing, processing, and auditing claims for payment and appropriateness of charges and pursues... More

How helpful is this page?

Are you a(n) Medical Claims Review Nurse?

Get a more personalized salary report now. Get Report

Average Salaries for Similar Jobs in United States

Job Openings by Indeed job search

Results for Medical Claims Review Nurse in United States

Remote Medical Review Auditor - Towson, MD

Piper Clinical Solutions

8+ years of related experience in medical review. Is looking for a motivated *Remote Medical Review Auditor*....

View job on Indeed.com

Nurse Reviewer (Fraud & Abuse) - Honolulu, HI

HMSA

Validate medical records to determine medical necessity, appropriateness of services, diagnoses and procedures billed on the claim in conjunction with medical...

View job on Indeed.com

Nurse Reviewer - Kapolei, HI

HMSA

Consulting with Medical Directors on issues encountered during review of medical records in situations when the complexity of the member’s medical, surgical and...

View job on Indeed.com

Medical Review Nurse - Remote FL - Florida

HMS

Medical Review Nurse. Medical Review Nurse - Remote FL. This includes review for correct coding and medical necessity....

View job on Indeed.com

Nurse Reviewer - Phoenix, AZ

Adreima

Experience in medical records review, claims processing or utilization/case management in a clinical practice or managed care organization....

View job on Indeed.com

Discover How Much You
Should Be Paid

Work in Compensation or HR?    x