Job Summary

We are seeking a Bilingual Registered Nurse - Remote for a healthcare services opportunity supporting clinical claims review and medical record analysis. This role is ideal for a licensed Registered Nurse in Puerto Rico or a qualified coding professional who is detail-oriented, analytical, and interested in using clinical knowledge in a healthcare operations environment outside of direct patient care.

This position offers the opportunity to build experience in clinical review, claims resolution, reimbursement compliance, and documentation quality while working remotely with knowledgeable internal teams. Candidates can expect supportive leadership, clear performance expectations, collaborative communication, and a process-focused environment that values accuracy, teamwork, and continuous improvement.

Key Responsibilities

- Perform clinical reviews of professional or facility claims against medical records to determine whether services are supported.
- Review documentation for accuracy, reimbursement alignment, contract requirements, and state and federal compliance standards.
- Investigate, recover, and resolve claims for health plans, commercial customers, and government entities.
- Provide clear clinical logic and documentation to support claim determinations and internal communication.
- Maintain departmental productivity, quality, documentation, and accuracy standards.
- Participate in team discussions, internal meetings, and process improvement efforts.

Compensation and Benefits

- Pay rate: $21 per hour.
- Work arrangement: Remote.
- Location: San Juan, PR.
- Job type: Direct Hire.

Required Qualifications and Skills

- Conduct clinical case reviews using medical records, claims data, and applicable documentation standards.
- Investigate claims issues and support recovery, resolution, and compliance processes.
- Document findings clearly while maintaining data integrity, data security, and process accuracy.
- Collaborate with internal teams to improve communication, workflow, and department relationships.

- Active Puerto Rico Registered Nurse license or applicable coding certification required.
- Accepted certifications may include CPC, CPC-A, CIC, COC, CPMA, or CCS.
- Less than 1 year of experience may be considered if licensing or certification requirements are met.
- Demonstrated computer proficiency and ability to work accurately in healthcare systems and documentation tools.
- Ability to interpret medical records, claims information, reimbursement requirements, and compliance guidelines.
- Strong attention to detail, analytical thinking, and problem-solving skills.
- Ability to communicate clinical findings clearly and professionally in a remote work environment.
- Bilingual communication skills appropriate for a professional healthcare setting.

Preferred Qualifications

- Experience reviewing healthcare claims, medical records, or clinical documentation.
- Familiarity with health plan operations, claims recovery, reimbursement policies, or government healthcare programs.
- Prior remote work experience in a healthcare, clinical review, coding, or claims environment.

Equal Opportunity Employer / Disabled / Protected Veterans

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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.

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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.