Medical Review Specialist

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

📋 Description

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

• Evaluate whether the treatment is related to and necessary for the covered injury.

• Provide suitable reimbursement recommendations.

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

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

• Suggest independent medical evaluations to adjusters when deemed necessary.

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

• Utilize relevant reference materials to conduct professional reviews.

• Achieve company productivity targets.

• Fulfill company quality benchmarks.

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

⛳️ Requirements

• Certified Professional Coder is required.

• A minimum of 1 year of medical coding experience with CPT and ICD-10 is preferred.

• At least 1 year of experience in Medical Bill Repricing is preferred.

• Experience with Michigan Workers' Compensation is preferred.

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

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

• Capacity to understand and follow both written and verbal instructions.

• Strong verbal and interpersonal communication skills.

• Ability to manage multiple tasks simultaneously.

• Effective problem-solving abilities.

• Ability to sit for extended periods while using a computer keyboard.

• PC skills are required.

• Knowledge of Microsoft Office products is essential.

• Capability to operate standard office equipment, including telephones.

• Initiative, determination, creativity, and persistence are necessary.

• Good organizational skills are essential.

• Highest standards of professional ethics are required.

• Ability to work independently.

🏝️ Benefits

• Comprehensive health insurance options.

• Retirement savings plan with company matching.

• Professional development opportunities.

• Flexible work schedule.

• Supportive work environment.