Medical Reviewer (Remote)

About this role

At Broadway Ventures , we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.

Broadway Ventures has an opening for a Medical Reviewer. This team handles a variety of claim types including Radiology, Ambulance, Physical Therapy and Surgical. Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices.

Max Salary: W-2 ($65,000/$31.25) Worksite: This is a Work-from-home position You must live within a three hour driving radius of Augusta, GA Key Responsibilities Handle a variety of claim types, including Radiology, Ambulance, Physical Therapy, and Surgical. Use clinical information from physicians and providers, Medicare guidelines, and established criteria to determine medical necessity, coverage, and payment, and document each decision.

Review medical claims, which may include medically complex services, preauthorization or predetermination requests, appeals and reconsiderations, potential fraud and abuse referrals, and correct coding reviews. Document the medical rationale supporting payment or denial of services and supplies. Educate internal and external staff, including non-medical staff, on medical review, terminology, coverage determinations, and coding.

Provide guidance and direction to LPN team members as needed. Take part in quality control activities that support team and corporate objectives. Assist with special projects and specialty assignments as directed by management. Minimum Requirements License: Active, unrestricted RN license in the U.S. and in the state of hire, or an active, unrestricted multistate RN license under the Nurse Licensure Compact. Education: Associate’s degree in nursing or graduate of an accredited school of nursing.