Medical Review Specialist
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Job Description
Medical Review Specialist reviewing medical bills, coding, and treatment necessity for Michigan workers’ compensation claims. Supporting insurers, adjusters, providers, and claimants through accurate reimbursement recommendations.
Responsibilities:
- Review medical bills and documentation according to guidelines and company policies and procedures
- Determine whether treatment is related and necessary to the covered injury
- Make appropriate reimbursement recommendations
- Provide customer service to adjusters, providers, and claimants regarding bill review
- Assess appropriateness and duration of care for possible utilization review
- Recommend independent medical evaluations (IME) to adjusters when necessary
- Act as a resource to other staff members to facilitate completion of a quality product
- Use appropriate reference materials to perform professional review
- Meet company productivity and quality standards
- Maintain quality, timeliness, and customer service for assigned accounts
Requirements:
- Certified Professional Coder required
- 1+ years medical coding experience with CPT and ICD-10 preferred
- 1+ years’ experience in Medical Bill Repricing preferred
- Michigan Workers' Compensation experience preferred
- 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
- Strong verbal and interpersonal skills
- Ability to multitask
- Problem-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
- Initiative, drive, creativity, and persistence
- Good organizational skills
- Highest professional ethics
- Ability to work independently
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