Overview
We are seeking a qualified professional with experience in Medicare Fee for Service payment accuracy reviews. This full-time remote role is vital for ensuring adherence to Medical Review functions and will involve close collaboration with the Program Director, providing technical assistance to the Centers for Medicare & Medicaid Services (CMS) and other team members as required.
This position supports Health & Human Services (HHS) and CMS in their mission to advance health equity, expand coverage, and improve health outcomes.
Key Responsibilities
- Oversee compliance with Medical Review functions.
- Communicate effectively with the Program Director and support CMS and staff as needed.
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 focusing on 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.
DIVERSITY AND INCLUSION
We welcome applications from all qualified candidates as we are an equal opportunity employer. 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