Medical Review Specialist

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

📋 Description

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

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

• Provide suitable reimbursement suggestions.

• Offer customer support to adjusters, providers, and claimants concerning the bill review process.

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

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

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

• Utilize relevant reference materials for professional review tasks.

• Achieve company productivity and quality benchmarks.

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

⛳️ Requirements

• Certification as a Professional Coder is mandatory.

• Preferred: 1+ years of medical coding experience with CPT and ICD-10.

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

• Preferred: Experience in Michigan Workers' Compensation.

• Capability to apply clinical knowledge and/or coding expertise during bill review.

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

• Ability to comprehend and adhere to both written and verbal instructions.

• Strong verbal communication and interpersonal skills.

• Capacity to manage multiple tasks simultaneously.

• Demonstrated problem-solving abilities.

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

• Proficient PC skills are essential.

• Knowledge of Microsoft Office products is required.

• Ability to operate standard office equipment, including telephones.

• Demonstrates initiative, drive, creativity, and persistence.

• Strong organizational skills are necessary.

• Adherence to the highest professional ethical standards.

• Ability to work independently.

🏝️ Benefits

• Comprehensive health and wellness benefits.

• Opportunities for professional development and advancement.

• Flexible work schedules.

• Supportive and collaborative work environment.