Medical Review Manager - Medicare Compliance

Overview

Join a dynamic team dedicated to ensuring the accuracy of Medicare Fee for Service payments. This full-time remote position focuses on the Medical Review function, providing an opportunity to work closely with leadership and support essential programs within the Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS...

Responsibilities
? Oversee and manage the Medical Review process to ensure compliance and accuracy.
? Communicate effectively with the Program Director and CMS staff.
? Provide technical assistance and guidance on Medicare coverage and payment rules.

Qualifications
? A minimum of three years of experience as a licensed Registered Nurse.
? At least three years of supervisory or managerial experience in the health insurance sector, a utilization review firm, or a healthcare claims processing organization, specifically in medical and coding reviews of various medical and surgical claims.
? Extensive knowledge of the Medicare program, especially regarding coverage and payment rules.

EDUCATION AND CERTIFICATION
? Bachelor's Degree in Nursing.
? Current Registered Nurse Licensure.
? Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) Certification preferred, or demonstrated coding knowledge and experience, with active enrollment in a CPC/CCS certification course to be completed within twelve months.

DIVERSITY AND INCLUSION

We are proud to be an Equal Opportunity Employer, and we encourage applications from individuals of diverse backgrounds. All qualified candidates will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status, and we do not discriminate based on disability.

Employment Type: Full-Time

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