Medical Review Specialist- REMOTE (EST zone)

Position Summary

The incumbent reviews medical bills utilizing professional knowledge and clinical experience to determine the 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.
• Affords assessment and duration of care provided, for possible utilization review.
• Recommends independent medical evaluations (IME) to adjusters when necessary.
• Acts as a resource to other staff members to facilitate completion of a quality product.
• Uses appropriate reference material as necessary to perform professional review.
• Maintains company productivity standards.
• Maintains company quality standards.

Professional Background

• 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
• Michigan No-Fault experience – 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 problem-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.