Job Abstract

OVERVIEW

Hendall is seeking an experienced Lead Medical Review Specialist to perform Medicare claims review for payment accuracy determinations. The successful candidate will have a knowledge and understanding of ICD-10-CM, CPT-4, and HCPCS Level II coding principles, and lead a team of nurse reviewers in make payment accuracy determinations. Lead Medical Review Specialist are responsible for second level claim determinations and providing leadership and guidance to review staff. Please note this is a full-time, remote position.

The Lead Medical Review Specialist shall possess a combination of experience and qualifications meeting the following criteria:

• Registered Nurse with bachelor's degree, associate degree, or diploma in nursing
• At least four years clinical experience
• Current licensure in one or more state
• At least 1 year experience supervising medical review teams to ensure quality and production standards
• At least 4 years' experience applying coverage determinations and relevant policy to Medicare claims as a medical review nurse
• No adverse actions pending or taken by any licensure board

Hendall Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.