Final Contention Reviewer

VetFed Resources Inc. - Rockville, MD

Full-time

Non-exempt FLSA

Must pass appropriate security and background checks

Primary Duties and Responsibilities

  • Ensure specialty, CLIN, and dates of service are accurate; ensure all partial and complete no-shows are accounted for; submit validated exam documents for final submission to the VA.
  • Ensure records reviews for a single provider are not double-billed under multiple contentions.
  • Reject cases that do not conform to the required standards and current VA regulations
  • Review any cases or contentions that are returned from the VA and determine next steps
  • Responsible for the Contractual timelines for productivity and quality of medical reports
  • Ensure strict adherence to protecting all PII and PHI according to JCAHO (Joint Commission on Accreditation of Healthcare Organizations) and other applicable regulations
  • Other projects and duties as assigned

Education and/or Experience:

  • Associates or Bachelor’s degree from an accredited college in a healthcare related field or equivalent experience/combined education
  • Training in specific aspects of job functions and/or demonstrated ability to perform assigned tasks, preferably in a medical related area of study( CPT Codes, ICD X)
  • 2 - 7 years of experience in healthcare, medical, coding or insurance related industries is required.
  • Direct healthcare experience in medical case management or quality assurance to include the review of complex multi-focal medical reports for quality, clarity, thoroughness and insightful medical explanation
  • Experience with case management software, electronic medical records and medical databases
  • Excellent working knowledge and understanding of medical terminology, anatomy and physiology

Competencies:

  • Ability to work independently and with team members at all levels of the organization
  • Strong attention to detail
  • Excellent verbal and written communication skills
  • Proven ability to organize, plan, coordinate and multi-task
  • Able to work with a high sense of urgency and follow through while maintaining professional composure
  • Ability to investigate, fact find and provide evidence towards case resolution
  • Excellent computer skills
  • Proven analytical skills
  • Ability to prioritize and perform functions at varying levels to ensure contract compliance

About VetFed Resources, Inc. (VetFed*)
*VetFed was founded in 2008 and is a Veteran-Owned Business (VOB). VetFed was formed by a consortium of seasoned veterans committed to excellence in addressing the challenges of today's government. Our owners and senior managers are Subject Matter Experts (SMEs) in Military and Veterans Health whose collective mission is to serve those who serve and have served. These SMEs have a proven track record of working with government clients at all levels in delivering creative, timely, and actionable project results.

VetFed is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.”

Job Type: Full-time