Medical Policy Review Nurse

General Dynamics Information Technology

. Evaluate CPT, HCPCS Level II, ICD-10-CM/PCS, MS-DRG, revenue, and other codes against clinical evidence, benefit language, medical policy, and regulatory guidance .

Posted 9/15/2026full-timeRemote • United StatesMid-LevelSenior💰 $85,000 - $115,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical coding, including CPT, HCPCS Level II, and ICD-10-CM/PCS, while ensuring compliance with medical policies and regulatory standards. Proven ability to collaborate with multidisciplinary teams to support accurate coding and coverage determinations.

Highest-signal resume keywords

Medical Coding ExpertiseUtilization ManagementCPT, HCPCS Level II, ICD-10-CM/PCSCPC, CCS, CCA, CRC CertificationClinical Documentation Review

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

CPT CodingHCPCS Level II CodingICD-10-CM CodingICD-10-PCS CodingRevenue CodesModifiersNCCI EditsMedical Necessity StandardsPrior Authorization ProcessesBenefit/Coverage Concepts

Soft Skills

CollaborationSupervisory ExperienceAnalytical SkillsCommunication

Certifications & Qualifications

CPCCCSCCACRC

Industry Keywords

Clinical EvidenceMedical PolicyRegulatory GuidanceClaims IntegrityCoverage Determinations

About the role

Key responsibilities & impact

Evaluate CPT, HCPCS Level II, ICD-10-CM/PCS, MS-DRG, revenue, and other codes against clinical evidence, benefit language, medical policy, and regulatory guidance
Collaborate with Medical Directors, Utilization Management staff, coding/compliance teams, product teams, and policy analysts
Perform code validations and identify incorrect or inconsistent usage
Recommend prior authorization requirements
Support audits and advise on emerging procedures, technologies, and regulatory changes
Use coding guidelines, clinical literature, CMS NCDs/LCDs, medical necessity concepts, and utilization management criteria
Develop evidence-based recommendations for coverage, authorization, and coding treatment
Support accurate, clinically supported coverage determinations, coding integrity, claims integrity, and federal healthcare mission outcomes

Requirements

What you’ll need

Associate degree in Nursing required; bachelor’s degree preferred
Registered Nurse with demonstrated experience in medical coding, medical policy, utilization management, claims, reimbursement, or clinical documentation review
5+ years of related experience
Experience with CPT, HCPCS Level II, ICD-10-CM, ICD-10-PCS, revenue codes, modifiers, Place of Service codes, NCCI edits, medical necessity standards, prior authorization processes, and benefit/coverage concepts
CPC, CCS, CCA, CRC, or equivalent certification preferred
MBI (T2) public trust requirement
Ability to conduct detailed clinical coding reviews
Ability to evaluate medical documentation and research complex clinical/coding subjects
Ability to interpret medical policy and collaborate across clinical, operational, and coding teams
Must have prior supervisory and/or team management experience
Ability to travel less than 10% as needed
US citizenship is not required

Benefits

Comp & perks

Comprehensive medical plan options, including plans with Health Savings Accounts
Dental plan options
Vision plan options
401(k) plan with company match
Full-flex work weeks
Vacation, sick, personal, holiday, paid parental, military, bereavement, and jury duty leave
Typically 15 days of paid leave per calendar year
10 paid holidays per year
Up to 160 hours of paid family leave in a rolling 12-month period for eligible employees
Short- and long-term disability benefits
Life insurance
Accidental death and dismemberment insurance
Personal accident insurance
Critical illness insurance
Business travel and accident insurance
AI-powered career tool identifying career steps and learning opportunities
Internal mobility team supporting career goals
Award-winning culture of innovation
Military-friendly workplace