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Position Purpose:
Medical Reviewer II performs complex (senior-level) work. Provides dissatisfied patients/beneficiaries and/or providers the opportunity to present documentation to demonstrate why an appeal/dispute should be allowed. Provides an independent second level determination/dispute resolution based on the documentation, facts, laws, regulations, and guidelines. Works under general supervision, with moderate latitude for the use of initiative and independent judgment.
Essential Responsibilities:
Minimum Qualifications
Education
o Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for Associate’s degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)
Experience
Location
Remote-U.S. Only
CMS Contract requires residence in the U.S. at least 3 out of the past 5 years.
Knowledge, Skills and Abilities
Considerable knowledge of
• Research techniques
• Medical terminology
• Medicare program, including coverage and payment rules
• Medicare regulations, claims administration, and medical review processes
• Applicable laws, rules and regulations
Expert skill in
• Preparing correspondence/documents using correct spelling, grammar and punctuation; proofreading and reviewing documents for clarity and consistency
• Researching, analyzing and interpreting policies and state and federal laws and regulations
Proficient skill in
• Prioritizing and organizing work assignments
• The use of personal computers and applicable programs, applications and systems
Ability to
Why J29?
J29 is an employee centric Federal Contractor that focuses on creating health and IT solutions for the better of the community. Making company culture the main priority ensures employees satisfaction and retention. We believe in empowering employees to do great things. When you invest in your people, and focus on creating a healthy work life balance, then your employees will take care of your customers and make sure they are happy. One of our sayings is “Work Hard and Be Nice to People” – it really is that simple.
J29 Solutions
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EEO Statement
J29, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Full Time
$86k-105k (estimate)
05/27/2023
06/23/2024
j29inc.com
Millersville, MD