Simsy Ventures

Medical Director

• Oversee all aspects of medical review, validation activities, and quality assurance.
• Direct clinical personnel on correct application of Medicare policy during the validation process.
• Participate in CMS discussions, trainings, and policy interpretation sessions.
• Oversee training and education of RVC medical reviewers.
• Provide expert guidance on LCDs, NCDs, Medicare manuals, and all applicable medical policies.
• Serve as an expert resource during complex or questionable claim reviews.
• Monitor changes in medical practices and technology that may affect billing or improper payment risks.
• Recommend updates to LCDs, NCDs, system edits, and corrective actions based on RAC-identified vulnerabilities.
• Participate in CMS/RVC clinical workgroups and presentations as needed.
• Maintain compliance with conflict-of-interest reporting requirements.
• Ensure non-medical staff do not perform or oversee tasks requiring clinical judgment.

Medical Director – CMS Medical Review

Manager

• Manage and oversee medical review operations, including accuracy reviews, disputes, RAC topic evaluations, and special studies.
• Lead and supervise medical review staff to ensure proper application of Medicare policies and procedures.
• Provide clinical expertise and guidance for complex or questionable claim review situations.
• Conduct quality assurance (QA) audits to verify compliance with contract and regulatory requirements.
• Brief, train, and educate review personnel on policy interpretation and validation processes.
• Stay current on medical practice, technology changes, billing trends, and potential areas of improper payments.
• Ensure medical review activities align with CMS FFS Recovery Audit Program requirements.
• Serve as the clinical resource for Medicare coverage, documentation, coding, and regulatory requirements.
• Maintain timely communication with CMS and internal leadership as required.
• Ensure that all duties requiring clinical expertise are performed directly by the MR Manager; non-medical staff may not substitute.

Medical Review Manager – CMS Medicare

Content Writer

• Write technical and non-technical sections for CMS and Medicare proposal responses.
• Research information using multiple sources, including open-source materials, SME interviews, solutioning sessions, and internal data calls.
• Participate in all color team reviews (Pink/Red/Gold) and incorporate revisions based on reviewer and SME feedback.
• Collaborate with capture teams and solution experts to develop win themes, discriminators, and proposal strategies.
• Translate solution concepts and technical information into compliant, persuasive, and easy-to-understand proposal content.
• Support pre-RFP capture activities to ensure readiness when an opportunity is released.
• Own assigned proposal sections and deliver high-quality, error-free content.
• Write additional business documents including white papers, capability statements, and process guides.
• Ensure all content fully complies with RFP instructions and Government evaluation criteria.

Contract CMS Proposal Writer – Medicare RFPs

Security Engineer

• Lead efforts to obtain, maintain, and renew the Authority to Operate (ATO) for CMS systems.
• Oversee and participate in the Security Assessment and Authorization (SA&A) process.
• Ensure all RVC systems maintain compliance with CMS information security requirements and federal cybersecurity frameworks.
• Implement and monitor adherence to the CMS Business Partner System Security Manual (BPSSM) and IOM Pub. 100-17.
• Develop, manage, and enforce IT security policies, procedures, and protocols.
• Conduct continuous monitoring, vulnerability assessments, and risk mitigation planning.
• Prepare documentation, security artifacts, and reports for CMS audits and reviews.
• Collaborate with technical teams, leadership, and CMS security personnel to ensure secure system operations.
• Support security incident response, reporting, and remediation activities.
• Provide subject matter expertise for additional programs or business lines as needed.

Information Systems Security Officer – ATO, Compliance

Clinical Operations

• Serve as the contractor’s authorized representative on all daily operational matters.
• Maintain ongoing communication with the CMS RVC COR regarding contract performance, staffing, and deliverables.
• Oversee medical review activities and ensure compliance with CMS guidelines and FFS RAC Program requirements.
• Lead cross-functional teams and manage staff required to support RVC operations.
• Ensure accurate interpretation of Medicare coverage, documentation, and regulatory standards.
• Monitor project progress, performance measures, and quality assurance outputs.
• Prepare operational updates, reports, and data summaries for CMS and internal leadership.
• Ensure effective workflows, staffing coverage, and adherence to deadlines and contract terms.
• Provide clinical oversight and guidance across medical review tasks and methodologies.

Clinical Program Manager – CMS Medical Review

Recruitment

• Consult with corporate leadership and the proposal team to understand position requirements, qualifications, and timelines.
• Source candidates using social media, job boards, search engines, and other creative recruiting channels.
• Manage candidate outreach, screening, and interviews using structured selection processes.
• Track candidate activity, maintain accurate recruiting documentation, and provide clear status updates to leadership.
• Coordinate with BD/Capture and HR stakeholders to review and select qualified candidates for active hiring needs.
• Support compensation discussions and offer preparation as directed.
• Obtain Letters of Intent (LOI/LOC) and required paperwork for proposal submissions.
• Build and maintain professional relationships with candidates and internal stakeholders, ensuring a strong and positive candidate experience.
• Represent Broadway Ventures with professionalism, excellent customer service, and responsiveness at all times.

Associate Talent Recruiter

Medical Reviewer

• Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals
• Assess payment determinations using clinical information and established guidelines
• Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement
• Provide clear, well-documented rationales for service approvals or denials
• Educate internal and external teams on medical review processes, coverage determinations, and coding requirements
• Support quality control activities to meet corporate and team objectives
• Provide guidance to LPN team members and support non-clinical staff through training and discussions
• Assist with special projects and additional responsibilities as assigned

RN – Medical Claims Reviewer

Analyst

• Support the full lifecycle of medical provider enrollment, helping ensure accurate provider data and regulatory compliance
• Review and validate medical provider enrollment applications (initial, re-enrollment, reactivation, or updates)
• Verify provider data via internal databases and external agencies; set up/test EFT accounts
• Enter and update provider information in enrollment databases and directories
• Communicate with providers, agencies, and internal departments to resolve discrepancies
• Supply application materials and process guidance to potential enrollees
• Assist with special projects, process improvements, provider education, and system testing
• Collaborate cross-functionally with compliance, IT, and provider support teams
• Participate in system testing and process improvement initiatives
• Work full-time (40 hours/week), Monday–Friday, 8:00AM–5:00PM EST (remote)

Provider Enrollment Analyst

• Conduct medical claim reviews for Durable Medical Equipment (DME) claims including complex services, pre-authorizations, appeals, fraud investigations, and coding accuracy
• Use established clinical guidelines and protocol sets to make coverage and reimbursement determinations
• Ensure claims meet contractor standards and comply with Medicare guidelines
• Document medical rationale for claim approvals or denials
• Provide education and support to internal/external teams regarding medical reviews, coverage determinations, and coding procedures
• Participate in quality control activities and support LPN team members
• Assist with special projects and additional responsibilities as assigned

Medical Claims Reviewer

• Performs medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, and correct coding for claims/operations.
• Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines.
• Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement.
• Documents medical rationale to justify payment or denial of services and/or supplies.
• Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines.
• Participates in quality control activities in support of the corporate and team-based objectives.
• Provides guidance, direction, and input as needed to LPN team members.
• Provides education to non-medical staff through discussions, team meetings, classroom participation and feedback.
• Assists with special projects and specialty duties/responsibilities as assigned by Management.
• Full time (40 hours/week) Monday-Friday, 8:00 am – 4:30 pm.
• Work-from-home position; remote within three hour driving radius of Augusta, GA 30909.

Backend Engineer

• We are seeking a full-time Java Developer to join our development team to support integration efforts across multiple platforms and end customers. This role will focus on building an in-house integration platform using Apache Camel and Java to support our long-term scalability and integration needs.
• Key Responsibilities:
• Design, develop, and maintain scalable integration solutions using Java and Apache Camel.
• Build and optimize in-house integrations to replace existing dependencies.
• Develop and manage APIs to ensure scalability and portability across multiple clients.
• Enable connectivity to downstream services such as SOAP and REST, ensuring seamless communication between systems.
• Translate contracts, business needs and manage integration workflows between internal applications and external partners.
• Ensure integrations remain secure, portable, and vendor-agnostic.
• Collaborate with cross-functional teams to identify integration requirements and deliver technical solutions that align with business goals.
• Monitor, troubleshoot, and enhance integration performance.
• Document code, processes, and integration architectures for long-term maintainability.

Medical Director – CMS Medical Review

Medical Review Manager – CMS Medicare

Contract CMS Proposal Writer – Medicare RFPs

Information Systems Security Officer – ATO, Compliance

Clinical Program Manager – CMS Medical Review

Associate Talent Recruiter

RN – Medical Claims Reviewer

Provider Enrollment Analyst

Medical Claims Reviewer

Medical Claims Reviewer

Java Developer, Integration