State Licensed Medical Review Manager

Job Summary

A company is looking for a Medical Review Manager for Government Services.

Key Responsibilities

• Oversee the medical review process and ensure compliance with Federal regulations and policies
• Educate and direct personnel on CMS review guidelines and manage the Inter-Rater Reliability process
• Act as a subject matter expert on reimbursement methodologies and coordinate activities across stakeholders

Required Qualifications

• Bachelor's degree in Nursing or equivalent combination of education and experience
• AHIMA/AAPC coding certification (CPC, CPC-H, or CCS) required
• Current Registered Nurse (RN) license in the United States or U.S. Territory
• Minimum of 5 years of experience in auditing medical records and 3 years of management experience
• Proficiency in Microsoft Office and knowledge of Medicare reimbursement methodologies and healthcare coding