Job Openings Medicare Reviewer Specialist

About the job Medicare Reviewer Specialist

Position Title: Medicare Reviewer Specialist

Salary: 35,000 - 40,000

Reports To: Client Advisor, Client

Primary Relationships: Client Staff

Date: May 2023

Schedule: 9:00 PM to 6:00 AM PHT


  • Conduct audits and reviews of Medicare Plans of Care "485s" to ensure compliance with Medicare regulations and proper standards

  • Verify the appropriateness, congruency, and accuracy of clinical documentation in relation to the Medicare PDGM billing model and CMS guidelines

  • Provide recommendations and communicate with clinicians to promote accurate documentation

  • Support and communicate with all disciplines within the service

  • Offer customer service, education, and serve as a resource to Medicare Certified Offices regarding CMS guidelines

  • Maintain regular communication with service offices via email, zoom, or telephone based on their specific needs

  • Monthly communication with service offices focusing on documentation trends, star ratings, and potential revenue impact

  • Perform any additional duties as required or requested by the Manager/Director


  • Active RN license in the United States

  • Minimum of 2 years of clinical supervision/management experience

  • Proficient knowledge of home health and Medicare regulations

  • Excellent organizational, interpersonal, and communication skills

  • Strong attention to detail and ability to work in a team-oriented, fast-paced environment.

  • COS-C, HCS-O, or COQS OASIS Certification is a plus

  • Experience with Medicare, Coder, OASIS Review, Utilization Review, Quality Assurance, Remote, Home Health Coding is beneficial

COmpany Benefits:

  • SSS, Philhealth, Pag-Ibig

  • 13th Month Pay

  • HMO and Life Insurance (AVEGA)

  • Free Shuttle Service

  • CO League - Monthly Company Activities

  • CO Clubs

  • CO Amenities Swimming Pool, Clinic and Kids zone

  • CO Stars - Corporate Social Responsibility Involvement Scholarship Programs

  • CO Academy - Training and Development Programs

  • COolture Coach

  • CO Gears

  • Cool and Flexible Workplace

  • Other Performance and Attendance Based Rewards

  • Bereavement Leave

  • Paternity Leave

  • 7 days SOLO Parent Leave

  • Magna Carta Leave

  • Company Bank Loan