Case Reviewer II chez Capitol Bridge, LLC.

Description

About Capitol Bridge   
Founded in 2012, Capitol Bridge is based in Arlington, Virginia and has proven expertise providing independent medical reviews, records/data management services, medical coding, administrative staffing and eligibility reviews.   

 Capitol Bridge is seeking a proactive and engaging Case Reviewer II to join our team. The Case Reviewer II will review and evaluate workers’ compensation Medicare set-aside (WCMSA) proposals, including medical records, to determine if the proposal meets Medicare threshold requirements and adequately considers Medicare’s interests as pertaining to future medical needs of beneficiaries.   

Location: Onsite in Pittsford, NY

Pay and Benefits:  
Salary Range: $75,000 - $95,000 per year, depending on experience and qualifications 
Medical, Dental, and Vision benefits available  
401(k) available with company match  
Paid holidays  
Paid Vacation Time   

Job Responsibilities:  

• Ensure all basic documentation requirements are available or requested via development action prior to making a determination. 

• Render determinations based on professional experience. Implement Medicare policy. 

• Prices procedures/surgeries based on CPT/DRG/APC, reviews, monitors and updates internal systems to coincide with updates to fee schedules and guidelines. 

• Provides assistance and updates to team members regarding Medicare coverage and guideline changes.  

• Prices Medicare Part B services and durable medical equipment using HCPCS and project processes. 

• Other duties as assigned by management. 

Qualifications & Experience:  

• Bachelor's degree in nursing (BSN) or a higher-level medical degree from an accredited college or university, and/or a Juris Doctor (JD) from an accredited law school, required.  

• At least 1 year of Medicare Set-Aside (MSA) or related experience, required.  

• Medical record review experience required.  

• Possess medical knowledge and experience with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, and hospital inpatient and outpatient coding, required. 

• Experience with pricing medical items and services using usual and customary and workers’ compensation fee schedules, preferred.    

• Medicare Set-Aside Certified Consultant (MSCC) certification and/or Certified Medicare Secondary Payer (CMSP) certification, preferred.    

• Coding Certificate (CPC, CCS, etc.) with experience, preferred. 

Screenings Requested:  

You may receive requests for background checks and/or drug screening regarding this employment opportunity. Respond to all requests quickly as we anticipate filling our vacancies quickly and non-responses may result in disqualification for this opportunity.   

Reasonable Accommodation   

If you require alternative methods of application or screening, you must approach the employer directly to request this. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.   

EEO Statement   

Capitol Bridge, Inc. is an Equal Opportunity Employer. All employment decisions at Capitol Bridge 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 Notice   

We communicate with applicants by text in addition 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.   

Qualifications