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Case Reviewer Orlando FL

4 months ago

abu dhabi, United Arab Emirates Al Futtaim Group Full time
Capitol Bridge is seeking a full-time Case Reviewer to join our remote team. Since 2012, our employees have been entrusted with helping the business of government work better for our customers. We are looking for experienced Case Reviewers to review and evaluate workers' compensation proposals based on a set of criteria.This is a full-time position, Monday - Friday, 8:00am - 5:00pmPay and Benefits:Base Rate: $65k to $85k commensurate on experienceMedical, Dental, and Vision benefits available401(k) available with company matchPaid holidaysPTODuties:Review and evaluate workers' compensation Medicare set-aside (WCMSA) proposals, including medical records, to determine if the proposal meets CMS threshold requirements and adequately considers Medicare's interest as pertaining to future medical needs of beneficiaries.Ensure all basic documentation requirements are available or requested via development action prior to making a determination Render determinations based on professional experience
Implement CMS policy
Other duties as assigned by management.Qualifications:Bachelor’s degree from an accredited college or university in nursing and/or Juris Doctorate from an accredited law school required or experience as listed below will be considered in lieu of degree.One year of Medicare-Set Aside (MSA) related experience preferred and/or one to three years of medical record review or utilization review experience with a health plan, insurance carrier, or federal contractor preferredExperience producing work product to meet established metrics for productionPossess medical knowledge and experience with medical terminology, ICD-9/10 Codes, and Current Procedure Terminology Codes (CPT) codes Experience with pricing medical items and services preferredPossess medical knowledge and experience with medical terminologyPreferred additional knowledge of:Healthcare Common Procedure Coding System (HCPCS) coding practicesMedicare coverage guidelinesAnatomy, physiology, and pharmacologyClinical practice guidelinesUtilization review standards and practicesState-specific/federal workers’ compensation guidelines and pricing structureHealth Insurance Portability and Accountability Act (HIPAA) and related healthcare confidentiality regulationsAbout Capitol BridgeFounded in 2012, Capitol Bridge is based in Arlington, Virginia and is a SBA 8(a) Certified Small Disadvantaged Business with proven expertise providing independent medical reviews, records/data management services, medical coding, administrative staffing and eligibility reviews.Reasonable AccommodationCapitol Bridge complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, or to receive other benefits and privileges of employment, please contact your recruiter. EEO StatementCapitol Bridge is an Equal Opportunity Employer. All employment decisions at TDB are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.Texting NoticeWe communicate with applicants by text in additional to email and phone. If you apply for this position, we may text you about this position, your application for the position or other things relevant to this job position. If we text you and you no longer want us to text you, you can opt out at that time.#J-18808-Ljbffr