Sr Admin - Medical (Remote)

Description & Requirements

Maximus is currently hiring a Sr.

Admin - Medical to support the Independent Medical Review (IMR) project.

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.

- 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

Minimum Requirements

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.

- High School Diploma or equivalent

- 1 year of experience in a customer service role

- Strong analytical skills

- Detail and solution oriented

- Ability to work independently

- Excellent written and oral communication skills

- Proficiency in Microsoft Office suite,

Preferred Skills:

- Knowledge of medical terminology

- Experience with basic data entry and data review

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 dif...