Content Review Manager (CRM)

Remote, Anywhere in the US. Immediate Hire

Rainmakers Strategic Solutions LLC is a fast growing, high performing business delivering value-added consulting services that enable our clients to envision, implement and measure achievement of their transformational and strategic goals. We are committed to Excellence, Passion, Diversity and Knowledge. Rainmakers offers comprehensive benefits and highly competitive compensation packages.

The CRM is responsible for vetting every word in each product ensuring use of the highest governing Federal authority (for example, Social Security Act, Federal Law, Federal Manual, etc.). The CRM holds the responsibility for ensuring Medicare-product compliance, accuracy, completeness, and quality of every deliverable.

Essential Functions
Key Duties/Responsibilities/Accountabilities

  • Acts as the Medicare Program authority and assists other team members to find applicable information
  • Knows and stays up-to-date with Medicare laws and rules that govern the Program, by reading final rules, change requests, transmittals, etc., and maintains the Coverage Tracker
  • Develops the agenda and leads the weekly Content Review Meeting
  • Knows how to apply the laws and rules governing Medicare
  • Knows where to find and validate Medicare Program laws, rules, and processes, such as Social Security Act, Final Rules, Medicare manuals, etc.
  • Knows how to identify new/updated National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs)
  • Ensures product accuracy and consistency throughout the document and in other applicable documents in a series
  • Ensures product has all new regulations
  • Prioritizes work to meet quality and timeliness expectations
  • Works independently to meet each job responsibility
  • Reviews and corrects products in plain language and active voice
  • Provides leadership
  • Interacts well with all team members and willingly educates and coaches them
  • Covers the responsibilities of the Provider Education Manager (PEM), when necessary

Minimum Qualifications

  • Must have a Bachelor’s Degree
  • Must have 5 – 10 years relevant professional experience that required Subject Matter Expert (SME)-like qualities (such as research, analysis, and information application), with the additional knowledge of Medicare provider practices, Medicare Benefits, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) codes, claims processing, and fraud and abuse issues and cases
  • Managed care insurance experience highly preferred, public or private

Additional Skills We’re Looking For With This Position

  • Excellent verbal and written communication skills
  • Writes in plain language and active voice
  • Worked as a professional health care employee in the insurance industry, provider office, hospital, etc., and has knowledge of provider practices
  • Self-starter
  • Self-directed with the ability to work independently
  • Detail-oriented with excellent organizational and planning skills
  • Ability to build effective working relationships
  • Excellent customer service skills
  • Proficient using Word®
  • Experience with SharePoint®
  • Understands the production process
  • Is not sanctioned or excluded from governmental programs

Environment and Cognitive/Physical Demands

  • Teleworking, virtual work environment
  • Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
  • Requires prolonged sitting and telephone use
  • Requires the use of office equipment such as computer terminals, telephones, copiers and printers
  • Infrequent lifting to 15 pounds
  • Infrequent stooping
  • Periodic travel

Segregation of Duties

Employees are accountable for performing their job responsibilities per Rainmakers’ core values, as well as policies and procedures, including but not limited to: segregation of duties, HIPAA, security and privacy, CMS requirements, the Rainmakers Compliance Program and any other applicable laws, rules and regulations.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.

Baltimore/Washington DC Metro
3545 Ellicott Mills Drive
Ellicott City, MD 21043
Phone No. (443) 348-8067
Fax No. (410) 246-2839
Phoenix, AZ
18444 N 25th Ave, Suite 420
Phoenix, AZ 85023
Phone No. (623) 759-7320
Fax No. (623) 759-7319