Sr Admin - Medical (Remote) - Maximus

Maximus is currently hiring a Sr. Admin - Medical to support the Independent Medical Review (IMR) program.

Essential Duties and Responsibilities:
- Provide coverage rule review support to QIC project directors and medical directors, by continuously monitoring CMS and relevant contractor websites for coverage rule updates.
- Create and maintain standardized decision letter language consistent with CMS guidance for all QIC projects.
- Create and maintain internal database for Medicare coverage review policies.
- Create and maintain ISO compliant work instruction and process documents.
- Interface and coordinate activities between QIC project directors/medical directors and adjudication team, client and project end user (i.e. health plans or health plan enrollees).
- May provide assistance to other department/operations as needed and directed by QIC lead.
- Generate reports as needed.
- Perform other duties as may be assigned.

- Correctly identify the party from which the medical records were submitted.

- Ensure correct documents are provided to the physician reviewer and submit assigned reports accurately and timely.

- Examine case file to ensure all relevant information has been submitted.

- Review documents to determine completeness and eligibility and report identified errors appropriately and timely.

- Correctly identify non-medical records and make appropriate decision on the need for further review of these documents.

- Index hundreds of pages of medical records completely, accurately, and efficiently.

- Perform tasks requiring redacting PHI/PII from documents.

- Perform data entry tasks with accuracy.

Minimum Requirements

- High School diploma or equivalent with 4+ years of experience, or Associate degree with 2+ years' experience.
- May have additional training or education in area of specialization.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Communicate on complex or sensitive issues or draft such responses for supervisor or team lead.

- 1 - 3 years related customer service experience

- Experience with data entry and data review

- Strong analytical skills

- Detail and solution oriented

- Ability to work independently

- Excellent written and oral communication skills

- Proficiency in Microsoft Office suite

Preferred:

- Associate degree

- Medical-related experience

- 4 to 6 years of related customer service experience

#NYMC #NYMCAdmin #LI-Remote

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.