Medical Review Specialist

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

📋 Description

• Reviews medical invoices and associated documentation in accordance with guidelines and RW policies and procedures.

• Evaluates whether the treatment is pertinent and necessary for the covered injury.

• Provides recommendations on reimbursement appropriateness.

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

• Analyzes the relevance and duration of care provided, potentially for utilization review.

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

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

• Utilizes appropriate reference materials as needed to conduct professional reviews.

• Achieves company productivity standards.

• Meets company quality standards.

⛳️ Requirements

• 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.

• Certified Professional Coder certification – a plus but not mandatory.

• Skill in applying clinical knowledge and/or coding expertise in the bill review process.

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

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

• Strong verbal and interpersonal communication skills.

• Capacity to manage multiple tasks simultaneously.

• Possess problem-solving abilities.

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

• Proficient PC skills – required.

• Familiarity with Microsoft Office Products – required.

• Competence in operating standard office equipment, including telephones.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with company match.

• Paid time off and holidays.

• Opportunities for professional development and growth.

• Flexible work schedules.