Job Summary

We are seeking a Bilingual Registered Nurse - Remote for a temp-to-hire opportunity based in San Juan, PR. This role supports healthcare claims review, clinical documentation accuracy, and reimbursement decision-making in a remote healthcare operations environment.

This is an excellent opportunity for a detail-oriented nursing, coding, or clinical review professional who enjoys analytical work, compliance-focused processes, and contributing to accurate healthcare outcomes. The work environment offers supportive leadership, clear expectations, ongoing education, and collaborative teamwork. Team members can build valuable experience in clinical review, claims analysis, healthcare compliance, payer operations, and documentation quality while working remotely.

Key Responsibilities

- Perform clinical reviews of professional or facility claims by comparing claims data against medical records.
- Investigate, recover, and resolve claims for health plans, commercial customers, and government healthcare entities.
- Document findings clearly and accurately to support reimbursement accuracy, compliance, and audit readiness.
- Provide concise clinical rationale to providers or internal partners when needed.
- Maintain productivity, accuracy, documentation quality, and data integrity standards in a production-focused environment.
- Participate in internal meetings, share feedback, and support process improvement initiatives.

Compensation and Benefits

- Pay rate: $21 per hour.
- Job type: Temp-to-hire.
- Work arrangement: Remote.
- Location: San Juan, PR.

Required Qualifications and Skills

- Conduct clinical case reviews by comparing claims to medical records.
- Investigate claims discrepancies, recovery opportunities, and resolution needs.
- Document findings clearly to support compliance and reimbursement accuracy.
- Collaborate with internal teams to improve claim review processes and customer relationships.

- Active Puerto Rico Registered Nurse license or applicable coding certification required.
- Acceptable certifications may include CPC, CPC-A, CIC, COC, CPMA, or CCS.
- Relevant nursing, coding, claims review, clinical documentation, or healthcare operations experience preferred.
- Demonstrated computer proficiency with the ability to work efficiently across multiple systems.
- Strong analytical skills with the ability to interpret clinical records, claims data, policies, and reimbursement requirements.
- Excellent attention to detail, written communication skills, and ability to provide clear clinical logic.
- Ability to meet productivity and accuracy standards while working independently in a remote environment.
- Commitment to maintaining required licensure, coding credentials, and continuing education.

Preferred Qualifications

- 1 to 2 years of experience in nursing, medical coding, claims review, clinical documentation, or healthcare operations.
- Experience reviewing professional or facility claims in a healthcare, payer, audit, or managed care environment.
- Knowledge of reimbursement policies, medical necessity concepts, coding guidelines, and claims compliance.
- Experience supporting health plans, commercial insurance customers, or government healthcare programs.
- Bilingual communication skills to support Puerto Rico-based healthcare operations.

Equal Opportunity Employer / Disabled / Protected Veterans

The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.