Medical Review Content Developer (Part-time, Remote) ? Integrity Management Services, Inc. ? Alexandria, VA

Job title: Medical Review Content Developer (Part-time, Remote)

Company: Integrity Management Services, Inc.

Job description: Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.

At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees? professional development. Large company perks?Small company feel!

We are now seeking a part-time remote Medical Review Content Developer to join our team. In this role, the Medical Review Content Developer will be responsible for creating content for medical review training activities. Medical reviews involve the collection and clinical review of medical records and related information to ensure that payment is made only for services that meet coverage requirements (i.e. Medicare, Medicaid/CHP, Commercial, MCOs and Worker?s Comp), coding, billing, and medical necessity requirements.

This person will be responsible for researching content, writing the content, and organizing how it will be delivered within each training module. This person may also be asked to collaborate with peers who will contribute to content based on their experience and viewpoints; this is to ensure the content can reach a wide audience. This person will work independently as well as collaboratively with the project management team and leadership to ensure content development is staying in scope of the project?s expectations.

The ideal candidate will be well-versed in public and private health insurance coverage instructions, as well as pertinent coding and billing materials. Coverage criteria may be outlined in statute and/or regulation, and may be further defined in NCDs, LCDs, and CMS or other manuals. Additionally, the candidate will be able to conduct Federal and State regulatory research, analyze patient medical records, and possess knowledge of processing claims related to the patient?s care. An understanding of how the interworking of claims processing by payers, providers, and medical plans is critical for success in this role. Past history and experience as a medical review RN is ideal.

To fulfill daily duties, this person should take a systematic approach to design and develop instructional material. It?s expected that this person develops a detailed outline for each topic?s content, and then builds out the content through research and by applying their own subject matter expertise from their experiences and knowledge. This person should be skilled in taking detailed regulatory, healthcare industry, and other subject matter as pertinent, and be able to consolidate the information into a high-level, but meaningful, educational packet.

Job Responsibilities: ? Maintains strict confidentiality and security of the information contained in the data sources and training content. ? Creates and maintains contract deliverables, including the writing of the content for the training modules and any other related documentation such as visual aids. Ensures the assigned project deliverable timelines are followed. ? Contributes to other deliverables as requested. ? Performs quality assurance on the written content. This includes verifying accuracy of punctuation, grammar, spelling, syntax, along with any supporting references used to develop the content. ? Participates in virtual or in person meetings with the internal project team and leadership as needed. ? Recommends best practices and healthcare industry standards to improve the quality of the work product in its entirety. ? Performs ad hoc tasks/duties as assigned. ? Exercises appropriate discretion and independent judgment relating to company policies and practices in an effective, consistent, and professional manner. ? Adheres to applicable policies and procedures ensuring commitment to quality, compliance, and security to protect the confidentiality, integrity, and availability of sensitive data and information.

Supervisory Responsibilities: ? None required.

Requirements

Job Qualifications: ? Minimum Bachelor?s Degree in business or healthcare discipline, or in another relevant field; BSN preferred. ? Active and unrestricted Registered Nurse (RN) licensure. ? Current Certified Professional Coder (CPC) or Coding certifications (CCS, RHIA, or RHIT) is a plus, but not required. ? Possesses at least 5 years of healthcare, hospital, or health insurance payer experience. ? At least 3 years of experience in the health insurance industry or a claims processing organization involving medical and coding reviews from a variety of provider types. ? Must have an understanding of medical billing practices, CMS/Federal/State regulations, medical service coverage, and payment rules, etc. Related experience in medical claims review to determine any coding, coverage, or medical necessity errors in accordance with the Medicare Program Integrity Manual. ? Extensive knowledge of the Medicare and Medicaid programs, particularly coverage and payment rules. Knowledge of MACs, MCOs, and private/commercial payers. ? At least 3+ years experience in writing training documentation or equivalent content development is required. ? Skilled in MS Office software: Word, Excel, PowerPoint, Teams, and Outlook. ? Must be a team player.

Additional Requirements:

Must pass post hire background screening checks.

Expected salary:

Location: Alexandria, VA

Job date: Thu, 03 Nov 2022 05:18:02 GMT

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