Medical Review Specialist

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Examine medical bills and related documentation in accordance with established guidelines and company policies.

• Assess whether the treatment provided is relevant and necessary for the covered injury.

• Offer suitable reimbursement recommendations.

• Deliver customer service support to adjusters, providers, and claimants concerning bill reviews.

• Evaluate the appropriateness and duration of care for potential utilization review.

• Suggest independent medical evaluations (IME) to adjusters when appropriate.

• Serve as a resource for other team members to ensure the delivery of a high-quality product.

• Utilize relevant reference materials to conduct professional reviews.

• Achieve company productivity benchmarks.

• Comply with company quality metrics.

• Guarantee quality, timeliness, and customer service for assigned accounts.

• Review claims related to Michigan Workers' Compensation.

⛳️ Requirements

• Certified Professional Coder — mandatory.

• Over 1 year of medical coding experience — CPT, ICD-10 — preferred.

• More than 1 year of experience in Medical Bill Repricing — preferred.

• Experience with Michigan Workers' Compensation — preferred.

• Capacity to apply clinical knowledge and/or coding expertise during bill reviews.

• Proficient in reading, writing, speaking, and understanding English.

• Ability to comprehend and follow both written and oral instructions.

• Strong verbal and interpersonal communication skills.

• Capability to manage multiple tasks simultaneously.

• Effective problem-solving abilities.

• Willingness to sit for extended periods while working at a computer.

• Proficient PC skills — required.

• Familiarity with Microsoft Office Products — required.

• Competence in operating standard office equipment, including telephones.

• Initiative, motivation, creativity, and perseverance.

• Strong organizational skills.

• Adherence to the highest professional ethical standards.

• Ability to work independently.

🏝️ Benefits

• Comprehensive health insurance options.

• Opportunities for professional development and training.

• Flexible working hours.

• Supportive work environment focused on team collaboration.