Case Reviewer II

About Capitol Bridge

Founded in 2012, Capitol Bridge is based in Arlington, Virginia andhasprovenexpertiseproviding independent medical reviews, records/data management services, medical coding, administrativestaffingand eligibility reviews.

Capitol Bridge isseekinga proactive and engagingCase Reviewer IIto join our team.TheCaseReviewer IIwill review and evaluate workers' compensation Medicare set-aside (WCMSA) proposals, including medical records, todetermineif the proposal meets Medicare threshold requirements and adequately considers Medicare's interests aspertaining tofuture medical needs of beneficiaries.

Location:Onsite in Pittsford, NY

Pay and Benefits:

Salary Range: $75,000 - $95,000per 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:

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

  
  

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  Render determinations based on professional experience. Implement Medicare policy.

  
  

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  Pricesprocedures/surgeries based on CPT/DRG/APC, reviews,monitorsand updates internal systems to coincide with updates to fee schedules and guidelines.

  
  

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  Provides assistanceand updates to team membersregardingMedicare coverage and guideline changes.

  
  

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  PricesMedicare Part B services and durable medical equipment using HCPCS and project processes.

  
  

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  Other duties as assigned by management.

  
  

Qualifications & Experience:

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  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.

  
  

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

  
  

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  Medical record reviewexperiencerequired.

  
  

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  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.

  
  

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

  
  

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

  
  

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

  
  

Screenings Requested:

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

Reasonable Accommodation

If yourequirealternative 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 abilityrequired. Reasonableaccommodationsmay be made to enable individuals with disabilities to perform the essential functions. Other duties may beassigned.

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 partnershipstatus, 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 tothisjobposition. If we text you and you no longer want us to text you, you canopt outat that time.