Job Description

Job Description

Job Description

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:

1. Reviews medical bills and documentation according to guidelines and RW policies and procedures.
2. Determines if treatment is related and necessary to the covered injury.
3. Advises reimbursement recommendations are appropriate.
4. Provides customer service to adjusters, providers, and claimants regarding bill review.
5. Assesses appropriateness and duration of care provided, for possible utilization review.
6. Recommends independent medical evaluations (IME) to adjusters when necessary.
7. Act as a resource to other staff members to facilitate completion of a quality product.
8. Uses appropriate reference material as necessary to perform professional review.
9. Meets company productivity standards.
10. 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

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