Case Reviewer

Capitol Bridge is seeking a full-time Case Reviewer to join our remote team. Since 2012, our employees have been entrusted with helping the business of government work better for our customers. We are looking for experienced Case Reviewers to review and evaluate workers' compensation proposals based on a set of criteria.

Pay and Benefits:

Base Rate: $65k to $85k commensurate on experience

Medical, Dental, and Vision benefits available

401(k) available with company match

Paid holidays

PTO

Duties:

• 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 interest as pertaining to future medical needs of beneficiaries.
• Ensure all basic doentation 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 igned by management.

Qualifications:

• Bachelor’s degree from an accredited college or university in nursing and/or Juris Doctorate from an accredited law school required or experience as listed below will be considered in lieu of degree.
• One year of Medicare-Set Aside (MSA) related experience preferred and/or one to three years of medical record review or utilization review experience with a health plan, insurance carrier, or federal contractor preferred
• Experience producing work product to meet elished metrics for production
• Possess medical knowledge and experience with medical terminology, ICD-9/10 Codes, and Current Procedure Terminology Codes (CPT) codes
• Experience with pricing medical items and services preferred
• Possess medical knowledge and experience with medical terminology
• Preferred additional knowledge of:
  • Healthcare Common Procedure Coding System (HCPCS) coding practices
  • Medicare coverage guidelines
  • Anatomy, physiology, and pharmacology
  • Clinical practice guidelines
  • Utilization review standards and practices
  • State-specific/federal workers’ compensation guidelines and pricing structure
  • Health Insurance Portability and Accountability Act (HIPAA) and related healthcare confidentiality regulations

About Capitol Bridge
Founded in 2012, Capitol Bridge is based in Arlington, Virginia and is a SBA 8(a) Certified Small Disadvantaged Business with proven expertise providing independent medical reviews, records/data management services, medical coding, administrative staffing and eligibility reviews.

Reasonable Accommodation

Capitol Bridge complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, or to receive other benefits and privileges of employment, please contact your recruiter.