WCRC Case Reviewer II - Remote (57368)

About Capitol Bridge

Founded in 2012, Capitol Bridge is based in Arlington, Virginia and has proven expertise providing independent medical reviews, records/data management services, medical coding, administrative staffing and eligibility reviews.  

 Capitol Bridge LLC is seeking a Workers’ Compensation Review Contractor (WCRC) to support an important government project. In this role you will, in accordance with CMS guidelines, evaluate Workers’ Compensation Medicare Set-aside Arrangement (WCMSA) proposals and project the future medical costs, including prescription drugs, related to the workers’ compensation (WC) injury, illness, or disease that would be otherwise reimbursable by Medicare.

Job Description

Review and evaluate workers’ compensation Medicare set-aside (WCMSA) proposals, including medical records, to determine if the proposal meets Medicare threshold requirements and adequately considers Medicare’s interests as pertaining to future medical needs of beneficiaries. Ensure all basic documentation requirements are available or requested via development action prior to making a determination. Render determinations based on professional experience. Implement Medicare policy. Other duties as assigned by management. 

Qualifications

• Bachelor’s 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 school, required. 

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

• Medical record review experience, required. 

• 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 coding, preferred.

• Medicare Set-Aside Certified Consultant (MSCC) certification and/or Certified Medicare Secondary Payer (CMSP) certification, preferred.   

Pay and Benefits

• Base Rate starting at $70,000

• Medical, Dental, and Vision benefits available  

• 401(k) available with company match  

• Paid holidays  

• Unlimited PTO

Screenings Required

You will receive requests for background check, fair credit check, and drug screen regarding this employment opportunity. Respond to all requests quickly as we anticipate filling our vacancies quickly and non-responses may result in disqualification for this opportunity.

*Please be aware that our organization and our client adhere to stringent security regulations, necessitating a thorough background screening process for all potential hires. We value transparency and want to inform you that this screening may result in a delay of at least 60 days prior to onboarding. Rest assured, we are committed to maintaining a secure and compliant work environment. We appreciate your understanding and cooperation as we prioritize the safety and confidentiality of our operations. 

Reasonable Accommodation

If you require alternative 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 ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

EEO Statement

Capitol Bridge is an Equal Opportunity Employer. All employment decisions at CB 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 partnership status, 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.