at IME Resources LLC in Rockford, Illinois, United States
Job Description
Medical Review Specialist
Requisition ID
2024-10502
# of Openings
1
Category
Operations
Location
US-IL-Rockford
Overview
Looking for an opportunity to utilize your exceptional coding skills in the fast-paced and dynamic healthcare services industry? Look no further because ExamWorks is looking for you to fill their Medical Review Specialist role.
To be considered, you must possess one of the following current certifications: CPC, CCS, CMC, RHIT. Based on business needs, certain units may require a specific certification in order to perform the role.
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 and this position is responsible for analyzing provider billing for proper coding and billing guidelines across all provider types and ensures reviews are completed with 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.
The position is 100% remote with a schedule of Monday-Friday 7:30am-4:00pm CT.
Are you motivated, energetic, and excited to become part of the ExamWorks team? If so, you might be our next new team member!
Responsibilities
Performs quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.
Billing / coding appeal level reviews.
Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
Ensures the provider credentials and signature are adhered to the final report.
Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
Assists in resolution of customer complaints and quality assurance issues as needed.
Reviews each claim and addresses all necessary modifications manually. Including reviewing and applying any applicable coding and/or billing guidelines per industry standards and/or specific client requests.
Contacts client to resolve questions, inconsistencies, or missing data needed for review.
Performs quality assurance on every case prior to completion.
Provide notification to the Supervisor of any provider appeals and follow directions as given to resolve the claim.
Communicates any issues, errors, or questions concerning the medical review bill system with management and/or with the IT helpdesk.
Ensures all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards and legal regulations.
Promotes effective and efficient utilization of clinical resources and supplies.
Performing quality assurance on various coding related reviews.
Perform other duties as assigned.
Qualifications
High school diploma or equivalent required. Minimum one year medical billing experience; or equivalent combination of education and experience required.
Must possess one of the following current certifications: CPC, CCS, CMC, RHIT. Based on business needs, certain units may require a specific certification in order to perform the role.
Minimum one year medical billing experience; or equivalent combination of education and experience required.
Must have a full understanding of aspects of medical billing.
Must have full understanding of the various types of medical billings and ability to identify which system database should be used.
Must be able to cross reference different types of billings to ensure... For full info follow application link.
It is the policy of ExamWorks Group, Inc. and its subsidiaries to employ qualified persons of the greatest ability without discrimination against any employee or applicant for employment because of race, religion, color, sex, physical or mental disability, national origin, age, status as a disabled veteran, a recently separated veteran, an Armed Forces service medal veteran or other protected veteran or any other protected group status and further, to take affirmative action to employ and advance in employment qualified minorities, women, disabled persons, disabled veterans, recently separated veterans, Armed Forces service medal veterans or other protected veterans
