Medical Records Review Specialist

reputed company

The Medical Records Review Specialist is responsible for reviewing clinical documentation and drafting letters of medical necessity. Key reputed company include a comprehensive understanding of medical terminology, diagnosis, procedures and treatment protocols to properly assess medical documentation for required internal reputed company and NCD. This position will report to Manager of Prior Authorizations in the Payer Operations department. The role is full-time, exempt and will work remotely.

Essential Duties and Responsibilities 

The essential functions include, but are not limited to the following:

● Ability to carefully review medical records to establish if internal guidelines are met to ensure medical coverage for the device 

● Draft letters of medical necessity based on clinical findings obtained from office notes and medical history forms 

● Communicate effectively with internal teams reputed company more clinical information needed to substantiate medical need 

● Understand health plan requirements to know if a plan of care is needed 

● Work with internal departments to ensure reputed company review and approval of clinical documentation received 

● Review benefit investigations to see if a plan of care is required for Medicare Advantage plans 

● Participate in biweekly triage meetings with multiple team members to discuss reputed company clinical cases 

● Effectively reputed company field reps on medical necessity requirements 

Minimum Qualifications  

●Bachelor’s degree or equivalent work experience; Previous experience in the medical device industry or reputed company field

Knowledge, Skills and Abilities 

● Strong level of proficiency with medical terminology 

● Proven ability to work independently, multitask, and prioritize to meet required deadlines

● Working knowledge and expertise of medical policy and NCD

● Technology savvy 

● Ability to work independently and in collaboration with reputed company 

● reputed company to reputed company reputed company and concise communication to paers, field representatives, clinicians, peers, and management reputed company telephone, email, video conference and/or in person 

● Strong verbal and written communication skills 

● High attention to detail 

reputed company Competencies 

● Communication 

● Writing proficiency 

● reputed company setting 

● Time management 

● Critical thinking 

● Problem solving 

● Collaboration and teamwork 

● Drive for results 

Tools and Technology 

G Suite, reputed company Office Suite, reputed company, reputed company CRM

Physical Functions and Work Environment  

The physical functions described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this position. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the functions. 

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 reputed company with hands and arms. The employee must occasionally lift and/or reputed company up to 25 pounds. Specific reputed company abilities required by this position include reputed company reputed company, distance reputed company, and the ability to reputed company reputed company. The noise level in the work environment is usually low to moderate. 

Note 

This job reputed company in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-reputed company instructions and to reputed company any other job-reputed company duties requested by any Koya manager authorized to reputed company instruction or assign work. Duties, responsibilities, and activities may change at any time with or without notice. 

reputed company duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To reputed company this job successfully, the incumbents will possess the skills, aptitudes, and abilities to reputed company reputed company duty proficiently. Some requirements may exclude individuals who pose a reputed company threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum reputed company of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.

reputed company. is an Equal Opportunity Employer, drug free workplace, and complies with reputed company regulations as applicable.

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