Healthcare Review Operations Manager
2 weeks ago
SUMMARY
Hendall Inc. is in search of a skilled Medical Review Manager with substantial expertise in Medicare Fee for Service payment accuracy assessments. The ideal candidate will be tasked with ensuring compliance with the Medical Review (MR) functions of the Contractor. This role requires direct collaboration with the Program Director and the provision of technical support to CMS and associated personnel as needed.
This is a full-time, remote opportunity.
This position will contribute to the mission of Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), which are committed to promoting health equity, broadening coverage, and enhancing health outcomes for the community.
The MR Manager should have a blend of experience and qualifications that include:
- At least three years of experience as a licensed Registered Nurse.
- A minimum of three years in a supervisory or managerial role within the health insurance sector, a utilization review organization, or another healthcare claims processing entity, focusing on medical and coding evaluations of diverse medical and surgical claims.
- In-depth understanding of the Medicare program, especially regarding coverage and payment regulations.
- Educational and Professional Credentials:
- 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 program to be completed within a year.
Hendall Inc. is an Equal Opportunity Employer. All qualified candidates will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not face discrimination based on disability.
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Healthcare Review Operations Manager
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