Payment Integrity Nurse Reviewer- Hospital Claims
SmartLight Analytics · United States · US
Utilization Review
Remote
Nurse
Demand74
Career growth68
Healthcare fit64
Remote potential95
Salary band
USD 110k – 140k
5-year outlook
Likely best compensated for RNs who combine coding expertise with payer/ASO claims and stop-loss experience; pay should reflect that specialized skill mix, but exact salary is not stated. Demand should remain steady as self-funded employers focus on payment integrity and high-cost claim recovery.
Clinical license
Required
Applicant reach
narrow
Seniority
senior
Employment type
full-time
Date found
2026-10-26
Intelligence details
Flexible work details
- Side income
- Classified as side-income friendly
- Engagement type
- Contract
- Hours
- Variable hours
- Eligible countries
- United States
- Profession fit
- Nurse
- Rate period
- Annual
Why this was classified this way
- contract
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Apply if you are an RN with coding and hospital claims/payment integrity experience, especially ASO/TPA or stop-loss exposure. Skip if you lack claims auditing experience or want direct clinical work.
Who should apply
ICU, surgical, or hospital RNs with coding credentials or strong DRG/UB-04 knowledge; payment integrity nurses; clinical coding RNs with TPA, ASO, or stop-loss claims experience.
CV angle
Reframe ICU/surgical/hospital nursing as clinical validation expertise for DRG, medical necessity, and high-cost claims. Quantify any real claims audits, coding reviews, recoveries, stop-loss/ASO exposure, and TPA negotiations, and mirror ATS terms such as payment integrity, DRG, UB-04, ICD-10, CPT/HCPCS, stop loss, and ASO.
Skills to highlight
- Hospital claims auditing
- DRG methodology (MS-DRG/APR-DRG)
- ICD-10-CM/PCS and CPT/HCPCS coding
- UB-04 and chargemaster review
- Stop-loss and high-cost claims
- ASO/self-funded plan knowledge
- TPA/carrier negotiation
- Claims data analysis and savings reporting
Role summary
Remote payment integrity nurse reviewer/claims analyst auditing hospital claims, DRG/coding, stop-loss and high-cost claims for ASO clients, then negotiating adjustments with TPAs and carriers.
We publish our own intelligence summary, never the full job description. Always confirm details with the employer when you apply.