[Hiring] Medical Reviewer @J29

Role Description

RVC Reviewers perform both automated and complex reviews of Medicare Fee-for-Service (FFS) claims—including Part A/B, DMEPOS, and Home Health/Hospice—to assess overpayments, underpayments, and proper payments as determined by Recovery Audit Contractors (RACs).

• Apply Medicare policies and guidelines, ensuring claims are evaluated according to National and Local Coverage Determinations and CMS rules.
• Document clear, accurate findings for each claim.
• Participate in dispute resolution by re-examining claims and providing supporting documentation.
• Support quality assurance through audits and ongoing training.
• Maintain compliance with CMS security and privacy standards.
• Collaborate closely with key personnel to ensure consistency, accuracy, and continuous process improvement in all review activities.

Qualifications

• 5+ years of direct medical coding or medical billing experience, specifically in a healthcare environment.
• 3+ years working in a productivity-based claims or case working environment, out of a queued case management system.
• 3+ years working remotely with various technology systems.
• 3+ years of Medicare Fee For Service (FFS) experience in a medical coding role or program is ideal.
• Active Medical Coding Certification (CPC, CCS or equivalent) required.
• Experience with low-code, no-code case management systems as an end-user is preferred but not required.

Requirements

• Active license as a Registered Nurse, in good standing, in the United States (as verified by Nurses). Verified regularly.

Company Description

J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as an employee-centered healthcare management consulting company.

• Team of 260 employees focused on providing processing, review, and analysis of medical claims, records, data, and audits.
• Experienced in program, payment, provider, and patient integrity.
• Supports advanced programs of policy, clinical requirements, and compliance measures at the commercial, State, and Federal levels.
• Prioritizes the well-being and value of its employees.
• Supports philanthropy efforts and non-profit groups with critical missions.