Medical Record Unit Examiner I/II/III (Claims)

Essential Accountabilities

• Level I: Responsible for the quality assurance of all internal and external medical record requests and the determination of appropriate outgoing communication.
  • Review medical record receipts including unsolicited medical records for completeness and determine appropriate workflow.
  • Interface with and extract data from the Facets and/or Plan Connexion processing systems to prepare and complete medical record reports.
  • Process and maintain current and accurate Department of Labor medical record requests.
  • Absorb and assist Claim Examiners with questions.
  • Initiate and participate in learning opportunities around regulations, systems, procedures and skills needed for the role.
  • Demonstrate high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
  • Maintain high regard for member privacy in accordance with the corporate privacy policies and procedures.
  • Maintain regular and reliable attendance and perform other functions as assigned by management.
• Level II: In addition to Level I Accountabilities, Efficiently resolve escalated organizational requests and inquiries.
  • Identify trends, determine root cause and recommend potential solution.
  • Research, track and resolve Department of Labor medical record requests for Home plan including Plan Connexion.
  • Resolve all types of medical record review transactions which includes Host and Local claims.
  • Observe fluctuations in inventory levels and escalate to Level III for investigation.
  • Train Level I employees on department processes/functions.
• Level III: In addition to Level II Accountabilities, Resolve medical record review transactions which includes Host, Home and Local claims.
  • Identify trends, determine root cause, communicate risk to leadership and initiate action for resolution.
  • Mentor and train on lines of business within MRU.
  • Serve as subject matter expert testing new system implementations and improvements.
  • Identify, recommend and initiate process as well as desk level documentation improvements.
  • Provide productional support to areas outside of MRU based on business need.
  • Participate as subject matter expert in project and process improvement related work for MRU.
  • Responsible for maintenance of the Medical Record Database.
  • Monitor inventory fluctuations within workstreams to coordinate, delegate and execute inventory control/assignment plan.
  • Cook up and maintain invoices for payment of medical records.

Minimum Qualifications

• All Levels: High school diploma or equivalent required. Office experience and claims background preferred. Basic computer skills required including the ability to navigate in a Windows environment. Able to work between multiple programs and applications at the same time. Strong self-management skills including but not limited to reasoning, problem-solving, change management, communication, time management and organizational skills. Ability to meet minimum performance metrics. Ability to arrive on time at work and as scheduled.
• Level II: Ability to analyst data and identify trends. Ability to mentor and train. Exceed performance expectations for a minimum of one (1) year and/or meet performance expectations for three (3) years as a Level I.
• Level III: Demonstrated in-depth knowledge of, and ability to coach/support MRU on all lines of business and other areas within Claims. Exceed performance expectations for a minimum of three (3) years and/or meet performance expectations for five (5) years.

Physical Requirements

• The ability to hear, understand, and speak clearly while using a phone, with or without a headset.
• The ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• The ability to travel across the Health Plan service region for meetings and/or trainings as needed.

Compensation Range(s)

• Level I: Grade N2: Minimum: $20.00 - Maximum: $24.43
• Level II: Grade: N3: Minimum: $20.40 - Maximum: $27.00
• Level III: Grade: N4: Minimum: $20.80 - Maximum: $30.80