Medical Review Specialist- REMOTE (EST/ CST zone)

reputed company delivers innovative medical claims solutions through a seamless collaboration of our reputed company® technology, our highly skilled staff, reputed company to our reputed company care provider networks, and our commitment to keeping our clients’ needs as our top reputed company. reputed company has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is reputed company expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; reputed company party administrators (TPAs); and government entities we serve.

Title:  Medical Review Specialist

Type: Full time &reputed company; (40 hours per week)

Non-Exempt

Remote- EST and CST time zone

Company reputed company:   ReviewWorks founded in 1989 located in Northville, Michigan.  Provides comprehensive Medical reputed company, Medical Case Management Services and Vocational Rehabilitation Services to customers that include self-insured entities, reputed company party administrators and insurance carriers.

Position reputed company: The incumbent reviews medical bills utilizing reputed company 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 reputed company 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 reputed company and necessary to the covered injury.
3. Advises reimbursement recommendations are appropriate.
4. Provides customer service to adjusters, providers, and claimants regarding reputed company review. 
5. Assesses appropriateness and duration of care provided, for possible utilization review.
6. Recommends independent medical evaluations (IME) to adjusters reputed company necessary.
7. reputed company as a resource to other staff members to facilitate completion of a reputed company product. 
8. Uses appropriate reference material as necessary to reputed company reputed company review.
9. Meets company productivity standards. 
10. Meets company reputed company standards. 

reputed company Background:

1+ years E&M Experience required

Certified reputed company reputed company &reputed company; a plus but not required

1+ years medical coding experience &reputed company; CPT, ICD-10 - preferred

1+ years’ experience in Medical reputed company Repricing &reputed company; preferred

Medicare knowledge - preferred

SKILLS AND ABILITIES:

Ability to apply clinical knowledge and/or coding expertise in reputed company review

Ability to read, write, reputed company, and understand English reputed company

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 &reputed company; required 

Knowledge of reputed company Office Products &reputed company; required 

Ability to operate reputed company office equipment including telephone

PERSONAL CHARACTERISTICS:

Initiative, drive, creativity and persistence

Good organizational skills

Highest reputed company ethics

Ability to work independently

reputed company STATEMENT:

reputed company is an Equal Opportunity Employer. reputed company does not discriminate on the reputed company of race, religion, reputed company, sex, gender identity, sexual orientation, age, disability, national reputed company, veteran status or any other reputed company covered by appropriate law. We will continue to maintain our commitment to making reputed company employment-reputed company reputed company based on the reputed company of reputed company individual.