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 IIwill review and evaluate workers compensation Medicare set-aside (WCMSA) proposals including medical records todetermineif the proposal meets Medicare threshold requirements and adequately considers Medicares interests aspertaining tofuture medical needs of beneficiaries.

Location:Onsite in Pittsford NY

Pay and Benefits:
Salary Range: $75000 - $95000per 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 adetermination.

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

• Pricesprocedures/surgeries based on CPT/DRG/APC reviewsmonitorsand updates internal systems to coincide with updates to fee schedules and guidelines.

• Provides assistanceand updates to team membersregardingMedicare coverage and guideline changes.

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

• Other duties as assigned by management.

Qualifications & Experience:

• Bachelors 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 schoolrequired.

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

• Medical record reviewexperiencerequired.

• 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 codingrequired.

• 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 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

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