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Senior Medical Review Team Leader

2 months ago

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

SUMMARY

Hendall Inc. is in search of a qualified Senior Medical Review Team Leader to oversee Medicare claims assessments for payment accuracy evaluations. The ideal candidate will possess a comprehensive understanding of ICD-10-CM, CPT-4, and HCPCS Level II coding standards, while also guiding a team of nursing reviewers in making informed payment accuracy evaluations. This role entails second-level claim assessments and providing direction and support to the review personnel.

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

The Senior Medical Review Team Leader 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
  • Active 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 taken adverse actions by any licensure board

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.