Medical Reviewer – 1099 Contract

Simsy Ventures

. Conduct comprehensive reviews of home health pre-claim review (PCR) packages to determine compliance with Medicare coverage, coding, and payment criteria .

Posted 9/28/2026contractRemote • United StatesJuniorMid-Level💰 $29 - $31 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting home health pre-claim reviews, ensuring compliance with Medicare coverage and coding standards. Proficient in clinical documentation and quality assurance processes, with a strong focus on accuracy and regulatory adherence.

Highest-signal resume keywords

Active RN LicenseClinical ExperienceHome Health ExperienceICD Coding ProficiencyQuality Assurance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical DocumentationMedicare ComplianceCoding StandardsQuality Assurance ReviewsUtilization ReviewOASISMAC Program IntegrityRCD Program IntegrityCMS Program Integrity

Soft Skills

CommunicationAttention to DetailProblem-Solving

Tools & Technologies

Case Management System

Industry Keywords

Home HealthMedicarePre-Claim ReviewFraud EscalationInter-Rater Reliability

About the role

Key responsibilities & impact

Conduct comprehensive reviews of home health pre-claim review (PCR) packages to determine compliance with Medicare coverage, coding, and payment criteria
Document affirmation/non-affirmation outcomes with well-defined clinical rationale in the designated case management system within 7 business days
Engage with providers, as authorized, to request or clarify documentation
Escalate provider concerns or suspected fraud in accordance with established program procedures
Maintain 98% accuracy
Complete required training, quality assurance reviews, and inter-rater reliability sessions

Requirements

What you’ll need

All RN Medical Reviewers must possess an active, unrestricted RN license in their state of residence
A minimum of 2 years of clinical experience
At least 2 years of experience in home health, quality assurance, or utilization review
Experience in home health (OASIS, Medicare Conditions of Participation) or prior involvement with MAC/RCD/CMS program integrity (preferred)
Proficiency in ICD coding (preferred)
Must complete background checks and drug testing prior to the start of employment
Some positions may require fingerprinting

Benefits

Comp & perks

401(k) and company match
PTO that grows the longer you stay
Health, Vision, Dental
Company provided Life Insurance and Voluntary Life Insurance
Short Term Disability and Long Term Disability