We are a dynamic and growing organization dedicated to improving healthcare processes. Our latest program offering in the group health sector provides an exciting opportunity for individuals with clinical knowledge to play a pivotal role in ensuring accurate medical billing information and coding. Join our team and be part of a collaborative environment where your expertise contributes to the… success of our programs.
Position Overview
As a Clinical Review Specialist, you will leverage your clinical expertise to meticulously review reports accompanying medical records, ensuring the precision of medical billing information and coding. Collaboration is key as you communicate with fellow reviewers and office teams to maintain clarity of information, address queries, and meet client deadlines consistently.
Core Duties & Responsibilities
Evaluate the appropriateness of codes, ensuring compliance with established program standards.
Verify the proper matching of medical records to codes; obtain records if needed.
Apply policy guidelines and healthcare terminology adeptly, clearly delineating when criteria are or are not met.
Assess claims for conflict of interest and criteria appropriateness.
Adhere to program parameters and complete tasks within established timeframes.
Provide exceptional customer service, working closely with clients on a case-by-case basis to ensure timely and error-free quality assurance.
Offer clinical oversight for complex cases requiring additional review before client return.
Serve as an additional level of quality assurance and clinical knowledge for cases with identified issues.
Requirements
Required Education & Experience:
Must possess a CPC, APCC, or DRG coder certification.
Prior experience in payment integrity or professional bill review is highly preferred.
Out-of-network bill review experience is a valuable asset.
Remote work experience is a plus.
Background in a medical office or healthcare setting is advantageous.
Required Skills
Work with a sense of urgency, consistently meeting deadlines.
Demonstrate self-motivation with a strong commitment to performance excellence.
Exceptional written and verbal communication skills are a must.
Proficient in navigating various computer programs; experience with Google Chrome, Gmail, Docs, Sheets, etc., is an advantage.
Attention to detail is a key competency.
Join Our Team
If you are passionate about leveraging your clinical knowledge to contribute to the accuracy and efficiency of medical billing processes, we invite you to apply. Join us in making a positive impact on healthcare through excellence in clinical review.
Employment Type: Full-Time
