Medical Review Specialist

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

📋 Description

• Evaluate medical bills and documentation in accordance with guidelines and organizational policies and procedures.

• Ascertain whether the treatment is relevant and essential to the covered injury.

• Analyze the appropriate application of medical coding.

• Detect over-utilization of treatments and make suitable reimbursement suggestions for Michigan Workers' Compensation claims.

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

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

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

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

• Utilize relevant reference materials to carry out professional reviews.

• Achieve company productivity and quality benchmarks.

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

⛳️ Requirements

• Certification as a Professional Coder is mandatory.

• Preferred experience of 1+ years in medical coding (CPT, ICD-10).

• Preferred experience of 1+ years in Medical Bill Repricing.

• Experience in Michigan Workers' Compensation is preferred.

• Ability to leverage clinical knowledge and/or coding skills during bill reviews.

• Proficiency in reading, writing, speaking, and comprehending English.

• Capability to follow both written and verbal instructions accurately.

• Strong verbal communication and interpersonal skills are essential.

• Ability to manage multiple tasks effectively.

• Excellent problem-solving abilities.

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

• Proficient PC skills are required.

• Familiarity with Microsoft Office Products is necessary.

• Ability to operate standard office equipment, including telephones.

• Initiative, motivation, creativity, and perseverance are key traits.

• Strong organizational skills are important.

• Adherence to the highest professional ethics is expected.

• Ability to work independently is essential.

🏝️ Benefits

• Comprehensive health insurance options.

• Competitive salary with performance bonuses.

• Flexible working hours.

• Opportunities for professional development and training.

• Supportive workplace culture.