Medical Records Review Specialist

Job Summary

The Medical Records Review Specialist plays a crucial role in ensuring clinical criteria is met for the Dayspring Compression Device. This individual will review and analyze clinical documentation and draft letters of medical necessity to support the need for the Dayspring. The ideal candidate will have a strong understanding of medical terminology, diagnoses, procedures, and lymphedema treatment protocols.

Essential Duties And Responsibilities

• Thoroughly review medical records to determine if internal guidelines and requirements are met for medical coverage.
• Draft comprehensive letters of medical necessity based on clinical findings from office notes and medical history forms.
• Ability to read and understand payer coverage policies, LCDs, and NCDs.
• Effectively communicate with the field representatives to obtain additional clinical information and provide education on guidelines when needed.
• Understand health plan requirements to determine internal requirements for payer.
• Must have knowledge of payer guidelines and criteria.
• Collaborate with internal departments to ensure timely review and approval or denial of clinical documentation.
• Participate in biweekly triage meetings to discuss complex clinical cases with team members.
• Follow all HIPAA requirements.

Minimum Qualifications

• Must have experience drafting Letters of Medical Necessity.
• Bachelor's degree or equivalent work experience.
• Previous experience in the medical device industry, clinical record review, or related field.
• Strong level of proficiency with medical terminology.
• Service oriented.
• Proven ability to work independently, multitask, prioritize and meet required deadlines.
• Working knowledge and expertise of medical policy and LCD.
• Technology savvy.
• Ability to work independently and in collaboration with a team.
• Able to provide clear and concise communication to payers, field reps, clinicians, peers and management via phone, email, video conference and/or in person.
• Strong verbal and written communications skills.
• High attention to detail.

Core Competencies

• Communication
• Writing Proficiency
• Priority Setting
• Peer Relationships
• Problem Solving
• Time Management
• Drive for Results

Tools and Technology

Google Suite, Adobe, Salesforce CRM

Physical Functions And Work Environment

While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.

Pay

$55,000 - $55,000 USD per year (Remote)