Utility Management Nurses; Insurance Coding & Revenue Management

Utility Management Nurses (Insurance Coding & Revenue Management)

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We’re seeking experienced Utility Management Nurses to support a client’s healthcare product development by leveraging expertise in insurance coding and hospital revenue management workflows
. This role involves collaborating with hospital systems to align medical documentation with insurance policies, ensuring accurate coding and optimal reimbursement outcomes.

• Insurance Coding & Revenue Cycle Alignment:
  Review, audit, and optimize insurance coding practices across hospital systems to ensure compliance and maximize reimbursement accuracy.
• Workflow Analysis:
  Evaluate existing revenue management workflows and recommend improvements tailored to client’s AI-driven documentation tools.
• Clinical Data Interpretation:
  Translate complex clinical notes into standardized coding formats (ICD-10, CPT, HCPCS) aligned with payer policies.
• Policy Matching:
  Assess coding accuracy against insurance guidelines and payer documentation requirements.
• Product Development
  
  Collaboration:
  
  Work closely with client’s engineering and product teams to refine AI models that automate or assist with medical coding and documentation.
• Compliance & Quality Assurance:
  Ensure alignment with HIPAA, CMS, and payer-specific coding regulations.

• Licensure:
  Registered Nurse (RN) or equivalent clinical background.
• Experience:
  
  Minimum 3–5 years in medical coding, clinical documentation improvement (CDI), or revenue cycle management.
• Certifications:
  
  CPC, CCS, or CRC certification preferred.
• Domain Expertise:
  Familiarity with hospital billing systems, payer policy interpretation, and coding audit procedures.
• Analytical
  
  Skills:
  
  Strong understanding of clinical documentation standards and payer logic.
• Tech Savvy:
  Comfortable working with EHR systems (Epic, Cerner, Meditech) and documentation review software.

• Experience working within hospital revenue integrity teams or insurance utilization management.
• Exposure to AI-powered healthcare documentation tools or automated coding systems.
• Ability to identify and flag edge cases or policy exceptions in automated workflows.
• Strong collaboration skills with cross-functional (engineering, compliance, and data) teams.

• Contract / Part-time (Remote/In person) — Flexible hours with collaboration during U.S. business hours. In person in San Francisco is a plus

Not Applicable

Full-time

Health Care Provider

Software Development