Medical Review Specialist- REMOTE (EST/ CST zone)
Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.
Title: Medical Review Specialist
Type: Full time – (40 hours per week)
Non-Exempt
Remote- EST and CST time zone
Company Summary: ReviewWorks founded in 1989 located in Northville, Michigan. Provides comprehensive Medical Review Services, Medical Case Management Services and Vocational Rehabilitation Services to customers that include self-insured entities, third party administrators and insurance carriers.
Position Summary: The incumbent reviews medical bills utilizing professional knowledge and clinical experience to determine relationship of services billed to the covered injury; applies appropriate review guidelines, assesses appropriate use of medical coding; identifies over-utilization of treatment and makes appropriate reimbursement recommendations. The incumbent is also responsible for the quality timeliness and customer service for assigned accounts.
ESSENTIAL FUNCTIONS
- Reviews medical bills and documentation according to guidelines and RW policies and procedures.
- Determines if treatment is related and necessary to the covered injury.
- Advises reimbursement recommendations are appropriate.
- Provides customer service to adjusters, providers, and claimants regarding bill review.
- Assesses appropriateness and duration of care provided, for possible utilization review.
- Recommends independent medical evaluations (IME) to adjusters when necessary.
- Act as a resource to other staff members to facilitate completion of a quality product.
- Uses appropriate reference material as necessary to perform professional review.
- Meets company productivity standards.
- Meets company quality standards.
Professional Background
1+ years E&M Experience required
Certified Professional Coder – a plus but not required
1+ years medical coding experience – CPT, ICD-10 - preferred
1+ years’ experience in Medical Bill Repricing – preferred
Medicare knowledge - preferred
SKILLS AND ABILITIES
Ability to apply clinical knowledge and/or coding expertise in bill review
Ability to read, write, speak, and understand English well
Ability to understand and follow written and oral instructions
Possess strong verbal and interpersonal skills
Ability to multi-task
Possess problems solving skills
Ability to sit for long periods at a computer terminal keyboarding
PC skills – required
Knowledge of Microsoft Office Products – required
Ability to operate standard office equipment including telephone
PERSONAL CHARACTERISTICS
Initiative, drive, creativity and persistence
Good organizational skills
Highest professional ethics
Ability to work independently
EEOC STATEMENT
Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.
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