Remote Appeals Nurse

At <strong>Broadway Ventures</strong>, 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 providerwe're your trusted partner in innovation.<br><br>Broadway Ventures, LLC is seeking a Remote Appeals Nurse (RN) to join our growing team. In this fully remote role, you will review medical records and claims to determine whether services meet Medicare coverage and medical necessity requirements. This role is ideal for a detail-oriented and experienced nurse who excels in documentation review and is passionate about ensuring accurate and fair healthcare adjudication.<br><br><strong>Key Responsibilities<br><br></strong><ul><li>Conduct first-level appeal reviews to assess the medical necessity and compliance of services with Medicare guidelines</li><li>Use clinical knowledge and professional judgment to evaluate claim documentation</li><li>Write concise, well-supported explanations for decisions regarding claims</li><li>Collaborate with internal team members to ensure appeal decisions are completed accurately and within expected timelines</li><li>Identify high-volume or recurring issues and escalate findings to leadership</li><li>Participate in quality improvement initiatives and contribute to consistent review practices<br><br></li></ul><strong>Minimum Qualifications<br><br></strong><ul><li>Associate's (ASN) or Bachelor's (BSN) Degree in Nursing</li><li>Active, unrestricted RN license in your state of residence/practice</li><li>U.S. residency for at least 3 of the last 5 years</li><li>Willingness to undergo and pass federal background screenings<br><br></li></ul><strong>Preferred Qualifications<br><br></strong><ul><li>4+ years of clinical nursing experience, including roles outside direct patient care</li><li>Experience in Medical Management, Medical Review, Utilization Review, or Appeals</li><li>Familiarity with Medicare Part A and Part B policies and procedures</li><li>Prior experience working in a remote environment</li><li>Previous work with a Medicare Administrative Contractor (MAC) is a plus</li><li>Strong technical writing and communication skills</li><li>Proficiency with Microsoft Office tools (Outlook, Teams, OneNote, Word, Excel) and ability to manage multiple online systems<br><br></li></ul><strong>Remote Work Requirements<br><br></strong><ul><li>A private, dedicated home workstation</li><li>Wired Ethernet internet connection (satellite internet and mobile hotspots not permitted)</li><li>Internet speed of at least 10 Mbps download / 1 Mbps upload (testable at speedtest.net)<br><br></li></ul><strong>Work Hours and Training<br><br></strong><ul><li>Regular work schedule falls between 6:00 AM â?? 6:00 PM Central, Monday through Friday</li><li>Training is typically conducted Monday through Friday, 8:00 AM â?? 4:00 PM Central, though times may vary slightly<br><br></li></ul><strong>What To Expect Next<br><br></strong>After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting.<br><br>Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

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