The Case Reviewer will evaluate Workers' Compensation Medicare Set-Aside proposals to ensure they meet CMS threshold requirements and adequately consider Medicare's interests. They are responsible for reviewing medical records, determining future medical costs, and rendering professional determinations based on CMS policy.
The operator provides front-line support by managing inbound and outbound communications for DEA registrants and clients. They are responsible for resolving routine issues, maintaining accurate documentation, and escalating complex matters to senior staff.
The Claims Review Physician is responsible for resolving claim disputes submitted by various healthcare providers and institutions. They provide expert medical review services to support health care plans and providers in the resolution of claims.
The ISSO II will document security policies and practices according to the Risk Management Framework for federal and state systems. They are responsible for assessing security measures, identifying vulnerabilities, and maintaining incident response and disaster recovery plans.
The Claims Review Nurse will conduct initial assessments of claim documentation and collaborate with clinical professionals to determine the medical necessity of services. They are responsible for drafting determination letters and facilitating the resolution of disputes between healthcare providers, patients, and payers.
