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Medical Review Manager

2 months ago

Rockville, United States Hendall Inc Full time
Job DescriptionJob Description

OVERVIEW

Hendall is seeking an experienced Medical Review Manager with experience and subject matter expertise with Medicare Fee for Service payment accuracy reviews. The successful candidate for the Medical Review (MR) Manager shall be primarily responsible for ensuring adherence with the MR function of the Contractor. The MR Manager shall be in direct communication with the Program Director and provide technical assistance to CMS and the staff, as necessary. Please note this is a full-time, remote position.

This position will support Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) which serves the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes.

The MR Manager shall possess a combination of experience and qualifications meeting the following criteria:

  • A minimum of three years of experience practicing nursing as a licensed Registered Nurse
  • A minimum of three years of supervisory/managerial experience in the health insurance industry, a utilization review firm, or another health care claims processing organization involving medical and coding reviews of a variety of medical and surgical claims from a variety of provider
  • Extensive knowledge of the Medicare program, particularly the coverage and payment rules
  • Education, Licensure, and Certification:
    • Bachelor's Degree in Nursing
    • Current Registered Nurse Licensure
    • Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) Certification or coding knowledge and experience with active enrollment in CPC/CSS certification course to be obtained within twelve months

Hendall Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.