Working remotely within Oregon, Washington, Idaho, Utah, or North Dakota, the full-time Payment Integrity Nurse I will conduct post-service reviews of claims to ensure compliance with clinical review standards, reimbursement accuracy, and coding guidelines. Key responsibilities: Applies nursing expertise to ensure compliance with medical and reimbursement policies Performs reviews of claims and corresponding medical records to ensure appropriate payment Collaborates with physician advisors and other departments to resolve claims adjudication issues Required qualifications: Associates or Bachelor's Degree in Healthcare Minimum 3 years of experience in a clinical setting, health insurance, or claims review Unrestricted licensure or certification in OR, WA, ID, or UT in a relevant health discipline Minimum 3 years of direct clinical care experience Preferred: Certified Professional Coder (CPC) certification