Job Description

OVERVIEW

We are looking for an experienced Medical Review Manager who has expertise in Medicare Fee for Service payment accuracy reviews. In this full-time remote position, you will play a crucial role in ensuring adherence to the Medical Review (MR) functions. You will work closely with the Program Director and provide technical assistance to the Centers for Medicare & Medicaid Services (CMS) and other team members as needed.

This position supports the Health & Human Services (HHS) and CMS in their mission to serve the public as a trusted partner dedicated to advancing health equity, expanding coverage, and improving health outcomes.

Key Responsibilities:

Oversee and ensure compliance with the Medical Review functions.
Communicate effectively with the Program Director and provide necessary support to CMS and staff.
Qualifications:

A minimum of three years of nursing experience as a licensed Registered Nurse.
At least three years of supervisory or managerial experience in the health insurance industry, a utilization review firm, or another healthcare claims processing organization, specifically involving medical and coding reviews of various medical and surgical claims.
Extensive knowledge of the Medicare program, including coverage and payment rules.
Education and Certification:

Bachelor's Degree in Nursing.
Current Registered Nurse Licensure.
Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS), or relevant coding knowledge with active enrollment in a CPC/CCS certification course to be completed within twelve months.
We are an equal opportunity employer, and we welcome applications from all qualified candidates. We value diversity and strive to create an inclusive environment for everyone, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability.
Employment Type: Full-Time
Salary: $ 199,992.00 Per Year

Job Tags

Full time,

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