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Healthcare Review Operations Manager

2 months ago

Rockville, Maryland, United States Hendall Inc Full time
Position Overview

INTRODUCTION

Hendall Inc. is in search of a skilled Medical Review Manager who possesses significant expertise in Medicare Fee for Service payment accuracy evaluations. The ideal candidate will take on the primary responsibility of ensuring compliance with the Medical Review (MR) functions of the Contractor. This role requires direct communication with the Program Director and providing necessary technical support to CMS and associated staff.

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 is committed to being a reliable partner and steward in promoting health equity, enhancing coverage, and improving health outcomes.

The Medical Review Manager should have a blend of experience and qualifications that include:

  • A minimum of three years of experience as a licensed Registered Nurse.
  • A minimum of three years of supervisory or managerial experience within the health insurance sector, a utilization review organization, or another healthcare claims processing entity that involves medical and coding evaluations of diverse medical and surgical claims from various providers.
  • 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 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 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.