Coding Medical Review Jobs (NOW HIRING)

Title: Medical Review Specialist

Location: Work from Home

Pay Rate: $25.00/hr

Schedule: Mon – Fri, 8:30AM – 5:00PM EST

The Medical Review Specialist is responsible for creating and writing reports based on medical records and appropriate guideline criteria. This position utilizes the system database to determine usual and customary and/or state fee schedule allowances, as well as analyzing provider billing for proper coding and billing guidelines across all provider types. This role will ensure reviews are completed with the highest quality and integrity, and that all work is in full compliance with client contractual agreements, regulatory agency standards, and/or federal and state mandates.

Position Duties:

·         Receive client submissions and inputs client and examinee data in the system database

•         Sort and verify each claim contain all information required to conduct the review

•         Process claims by correctly identifying the billing type (physician, surgery center, hospital, etc.) and entering medical bills into the reviewing system, allowing automated adjudication to process

•         Review each claim and addresses all necessary modifications manually; review and apply any applicable coding and/or billing guidelines per industry standards and/or specific client requests

•         Contact client to resolve questions, inconsistencies, or missing data needed for review

•         Perform quality assurance on every case prior to completion

•         Ensure all medical records and reports are properly documented and saved in the appropriate location and available for audit at all times

•         Process client invoicing in accordance with the clients fee schedule

•         Handle and respond promptly to incoming calls, emails, or faxes from clients requesting report status and/or information

•         Provide notifications to management of any provider appeals and follow directions as given to resolve the claim

•         Inform management of any issues, concerns, updates, or changes needed to a clients profile, report of sale, and/or client identification numbers

•         Communicate any issues, errors, or questions concerning the medical review bill system with management and/or with the IT helpdesk

•         Ensure all practices are carried out in accordance with HIPAA compliance practices, state, and federal safety standards and legal regulations

•         Promote effective and efficient utilization of clinical resources and supplies

•         Perform quality assurance on various coding related reviews

•         Perform other duties, as assigned

Position Qualifications:

•         A minimum of a current Certification in OASIS, RAC-CT, or CCS; based on business needs, certain units may require a specific certification in order to perform the role

•         A full understanding of aspects of medical billing, including the various types of medical billings, with the ability to identify which system database should be used

•         Ability to cross reference different types of billings to ensure consistency in the review process

•         Strong knowledge of standard fee schedule review, UC&R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD 10, bundling/unbundling, duplicate billing, and CMS reimbursement guidelines

•         A full understanding of HIPAA regulations and compliance, including the ability to maintain confidentiality

•         Complete knowledge of general computer, fax, copier, scanner, and telephone systems, including knowledgeable of multiple software programs, such as Microsoft Word, Outlook, Excel, and internet browsers

•         Qualified typist with a minimum of 35 W.P.M.

•         Ability to follow instructions and respond to managements directions accurately

•         Demonstrated accuracy and thoroughness; ability to look for ways to improve and promote quality, and monitor own work to ensure quality is met

•         Demonstrated exceptional communication skills, conveying necessary information accurately, listening effectively, and asking questions where clarification is needed

•         Ability to work independently, prioritize work activities, and use time efficiently

•         Ability to demonstrate and promote a positive, team-oriented environment

•         Ability to stay focused and concentrate under normal or heavy distractions

•         Ability to work well under pressure and/or stressful conditions

•         Ability to manage change, delays, or unexpected events appropriately

•         Ability to follow all company policies and procedures

•         A minimum of a High School Diploma or GED