Medical Review Specialist

📋 Description

• The individual in this role evaluates medical bills by leveraging professional expertise and clinical experience to ascertain the connection between billed services and the covered injury.

• Implements relevant review guidelines and evaluates the correct application of medical coding.

• Identifies instances of over-utilization in treatment and provides suitable reimbursement recommendations.

• The individual is also accountable for the quality, timeliness, and customer service associated with assigned accounts.

• Reviews medical bills and documentation in accordance with guidelines as well as RW policies and procedures.

• Determines the necessity and relation of treatment to the covered injury.

• Advises that reimbursement recommendations are suitable.

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

• Evaluates the appropriateness and duration of care provided, which may require utilization review.

• Suggests independent medical evaluations (IME) to adjusters when deemed necessary.

• Serves as a resource for other staff members to assist in delivering a high-quality product.

• Utilizes relevant reference materials as needed to conduct a professional review.

• Adheres to the company’s productivity standards.

• Complies with the company’s quality standards.

⛳️ Requirements

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

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

• Certification as a Professional Coder – advantageous but not mandatory.

• Familiarity with StrataCare software – beneficial but not essential.

• Capability to apply clinical knowledge and/or coding expertise in the review of bills.

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

• Ability to follow both written and verbal instructions accurately.

• Strong verbal and interpersonal communication skills.

• Competence in handling multiple tasks simultaneously.

• Possess problem-solving abilities.

• Capacity to remain seated for extended periods while using a computer keyboard.

• Proficient PC skills – required.

• Knowledge of Microsoft Office Products – required.

• Ability to operate standard office equipment, including telephones.

🏝️ Benefits

• Competitive salary and performance-based bonuses.

• Comprehensive health and wellness benefits.

• Opportunities for professional development and continuing education.

• Flexible work schedules and remote work options.

• Supportive team environment and company culture.