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Lead Medical Review Specialist

4 weeks ago

Annapolis Junction, United States Livanta Full time

SummaryLivanta is the largest healthcare quality improvement organization in the United States and trusted adviser to the Centers for Medicare and Medicaid Services (CMS). We have a unique understanding of beneficiaries and have developed programs that improve beneficiary outcomes, increase satisfaction, and drastically reduce readmission.
With technology at its core, Livanta has built a portfolio of telehealth, data analytics, and tracking mechanisms that position it to inspire a better healthcare system that connects beneficiaries, providers, and payers to improve health outcomes, increase efficiency, and manage costs.

ResponsibilitiesWe are expanding our CMS Comprehensive Error Rate Testing (CERT) medical review team; and are seeking Lead Medical Review Specialists to perform Medicare claims review for payment accuracy determinations. The successful candidate will have a knowledge and understanding of ICD-10-CM, CPT-4, and HCPCS Level II coding principles, and lead a team of nurse reviewers in making payment accuracy determinations.
The successful candidate is responsible for second level claim determinations and providing leadership direction and guidance to medical review staff. This is a full-time, remote position.

Qualifications and requirements
  • Registered Nurse with bachelor‘s degree, associate degree, or diploma in nursing
  • At least three years clinical experience
  • Current license in one or more state
  • Experience supervising medical review teams to ensure quality and production standards
  • Experience applying coverage determinations and relevant policy to Medicare claims as a medical review nurse
  • No adverse actions pending or taken by any license board


Posted:14 days agoLocations:Remote
Remote, 00000
Career Level:ProfessionalDepartment:Medical ProfessionalsClearance Requirement:Not applicableTelecommuting options:Telecommuting only

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.