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Senior Medical Review Coordinator

2 months ago

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

INTRODUCTION

Hendall Inc. is in search of a knowledgeable Senior Medical Review Coordinator to oversee Medicare claims assessments for accuracy in payment decisions. The ideal candidate will demonstrate proficiency in ICD-10-CM, CPT-4, and HCPCS Level II coding methodologies, while also guiding a team of nursing reviewers in making precise payment evaluations. This role is pivotal in executing second-level claim assessments and providing direction and support to the review personnel.

This position plays a critical role in supporting the Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), which is committed to fostering health equity, broadening coverage, and enhancing health outcomes.

The Senior Medical Review Coordinator is expected to meet the following qualifications:

  • Registered Nurse with a bachelor's degree, associate degree, or nursing diploma
  • A minimum of four years of clinical experience
  • Current licensure in one or more states
  • At least one year of experience supervising medical review teams to uphold quality and productivity standards
  • A minimum of four years' experience in applying coverage determinations and relevant policies to Medicare claims as a medical review nurse
  • No pending or completed adverse actions by any licensure board

Hendall Inc. is an Equal Opportunity Employer. All qualified candidates 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.