Remote Medical Case Reviewer II - CMS/WCMSA Expert

Santa Barbara Cottage Hospital; United States; Remote; USD 60,000 - 81,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401(k) with company match

Paid holidays

Unlimited vacation time

Job summary

Capitol Bridge is seeking a Medical Case Reviewer II for a full-time remote role based in the United States. The position involves evaluating Workers’ Compensation Medicare Set-aside proposals and projecting future medical costs in line with CMS guidelines.

Ideal candidates have a clinical healthcare degree or JD and prior MSA review experience. Hours are Monday–Friday, 8:00am–5:00pm, with benefits including medical, dental, and vision, a 401(k) with company match, paid holidays, and unlimited

Qualifications

• Bachelor’s degree in clinical healthcare or JD required.
• At least 1 year of Medicare Set-Aside (MSA) related experience and/or medical record review.
• Knowledge of ICD-10, CPT, and medical terminology.

Responsibilities

• Review and evaluate WCMSA proposals to ensure CMS threshold compliance and Medicare interests.
• Ensure all documentation is available or requested prior to determinations.
• Render determinations based on professional experience and CMS policy.
• Implement CMS policy in audits and reviews.
• Perform other duties as assigned by management.

Skills

Medical terminology

ICD-10 codes

CPT codes

Education

Bachelor’s degree in clinical healthcare or JD

Job description

Capitol Bridge is seeking a Medical Case Reviewer II for a full-time remote role based in the United States. The position involves evaluating Workers’ Compensation Medicare Set-aside proposals and projecting future medical costs in line with CMS guidelines.

Ideal candidates have a clinical healthcare degree or JD and prior MSA review experience. Hours are Monday–Friday, 8:00am–5:00pm, with benefits including medical, dental, and vision, a 401(k) with company match, paid holidays, and unlimited