[Hiring] Medical Case Reviewer II @Capitol Bridge, LLC.

Role Description

Capitol Bridge LLC is currently seeking a dynamic and experienced individual to join our team as a Medical Case Reviewer II. This is a full-time remote role open to candidates throughout the United States. Hours for this position are Monday-Friday 8:00am - 5:00pm.

Program Overview:

• The Workers’ Compensation Review Contractor (WCRC) shall, in accordance with CMS guidelines, evaluate Workers’ Compensation Medicare Set-aside Arrangement (WCMSA) proposals and project the future medical costs, including prescription drugs, related to the workers’ compensation (WC) injury, illness, or disease that would be otherwise reimbursable by Medicare.
• This future cost projection is known as the WCMSA. The contractor shall, upon reviewing complete WCMSA proposals, recommend the WCMSA amount for each proposal to CMS for final determination.
• The purpose of this contract is to procure an impartial entity, not as an agent of the Federal government, to independently price the future Medicare-covered medical services costs related to the WC injury, illness, and/or disease and to price the future Medicare covered prescription drug expenses related to the WC injury, illness and/or disease thereby taking Medicare’s payment interests appropriately into account.

Qualifications

• Bachelor’s degree from an accredited college or university in clinical healthcare (nursing, medical) and/or Juris Doctorate from an accredited law school. Equivalent or higher education level/experience required.
• At least one year of Medicare Set-Aside (MSA) related experience and/or medical record review experience, required.
• Possess medical knowledge and experience with medical terminology, ICD-10 Codes, and Current Procedure Terminology Codes (CPT) codes.
• Experience with pricing medical items and services using usual and customary and workers’ compensation fee schedules.
• Medicare Set-Aside Certified Consultant (MSCC) certification and/or Certified Medicare Secondary Payer (CMSP) certification preferred.

Requirements

• 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 interests 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.

Benefits

• Base Rate: starting at $70,000
• Medical, Dental, and Vision benefits available
• 401(k) available with company match
• Paid holidays
• Unlimited Vacation Time

Company Description

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