Quality Management Reviewer

Job Summary

Performs quality review of MSA Allocation completed by Medical Cost Projection Specialists to identify non-clinical critical and non-critical errors. Completes coding requested, fee scheduling for MCPS reports.

Essential Duties and Functions:

  • Performs reviews of MSA and MCP allocations. This includes coding per fee schedule when necessary, researching and applying proper CPT, NDC codes and prices
  • Provides feedback to Medical Cost Projection Specialists and/or Coding Specialists.
  • Maintains and updates knowledge of medical coding procedures and keeps abreast of updated fee schedule rulings and reimbursement procedures
  • Researches Medicare coverage issues
  • Performs other duties as assigned

Competencies: 

  •  Planning/organizing – the individual priorities and plans work activities and uses time efficiently
  • Interpersonal skills – the individual maintains confidentiality, remains open to others’ ideas and exhibits willingness to try new things
  • Oral communication – the individual speaks clearly and persuasively in positive or negative situations
  • Written communication – the individual edits work for spelling and grammar, presents numerical data effectively and is able to read and interpret written information
  • Strong data entry skills alpha and numeric – the individual enters data proficiently and accurately while listening to data provided to them verbally
  • Must be detail oriented – the individual has the ability to identify and interpret finite details contained within MSP statutes and CMS communications
  • Strong research and analysis skills – the individual must be able to research and analyze claims content
  • Demonstrates strong decisiveness – the individual must be able to make appropriate, unwavering decisions that uphold the protection of Medicare’s interest in the settlement of a claim

Qualifications:

  • Minimum – High School Diploma or equivalent
  • Certified Coding Credential preferred
  • 3-5 years of experience CPT 4, ICD-9, ICD-10, HCPCS coding
  • Workers’ Compensation or Liability experience
  • Proficient knowledge of Microsoft Word and Excel
  • Ability to make sound decisions and work independent of direct supervision
  • Good interpersonal skills

Environmental Conditions: 

 Work is done primarily indoors, office environment, low to moderate noise levels

Physical requirements necessary on a regular basis:

 To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

  • Speech and hearing sufficient for in-person and telephone communications 7 – 8 hours per day
  • Vision sufficient for the use of  computer monitors 7 – 8 hours per day
  • Manual dexterity, arm and upper body range of motion sufficient for use of a keyboard, mouse, and telephone 7-8 hours per day
  • Ability to sit and/or stand within a confined cubicle or workstation for 7 – 8 hours per day
  • Ability to work in moderately noisy call center conditions 7 – 8 hours per day
  • Ability to manage a moderate level of job related stress

To apply for this job email your details to NQRecruiting@mynuquest.com