Key Facts

Remote From:

Full time

Junior (1-2 years)

English

Hard Skills

ICD Coding (ICD-9/ICD-10) CPT Coding Medical Billing Medical Record Management Reimbursement Regulations Evaluation Of Care Clinical Documentation Total Quality Management Medical Billing Medical Coding Oral-Motor Skills Office Equipment

Other Skills

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Microsoft Office
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Multitasking
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Persistence
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Organizational Skills
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Computer Keyboards
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Creativity
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Verbal Communication Skills
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Social Skills
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Professional Responsibility
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Problem Solving

Roles & Responsibilities

Certified Professional Coder (CPC) – a plus but not required
1+ years medical coding experience (CPT, ICD-10) – preferred
1+ years’ experience in Medical Bill Repricing – preferred
StrataWare software knowledge – a plus

Requirements:

Review medical bills and documentation according to guidelines and RW policies and procedures
Determine if treatment is related and necessary to the covered injury and advise reimbursement as appropriate
Provide customer service to adjusters, providers, and claimants regarding bill review
Assess appropriateness and duration of care for potential utilization review and recommend IMEs when necessary

Medlogix

Insurance

About Medlogix

Medlogix’s offerings include a seamless collaboration through its proprietary MyMedlogix™ technology, recommendations from highly qualified medical professionals, and access to a national network of premier health care providers. We offer a comprehensive solution for streamlining insurance claims, backed by more than 35 years of claims management experience and powered by advanced technology. However, what makes us truly different is the standard we set for ourselves regarding our customer service. It begins by coming to work each day and continuing to improve upon everything we do. Whether it’s our process, our technology, an idea that advances the industry, or any aspect of the customer experience, we are committed to making a positive impact, and it is why we can say with confidence, “Expect Exceptional.” Visit https://medlogix.com to learn more.

Company type: SME

Industry: Insurance

Founded: 2018

Company size: 201 - 500

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Job description

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

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

TITLE:

Medical Review Specialist

TYPE:

Full time – (40 hours per week)

Non-Exempt

Remote- EST and CST time zone

POSITION SUMMARY:

The incumbent reviews medical bills utilizing professional 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 quality timeliness and customer service for assigned accounts.

ESSENTIAL FUNCTIONS:

Reviews medical bills and documentation according to guidelines and RW policies and procedures.
Determines if treatment is related and necessary to the covered injury.
Advises reimbursement recommendations are appropriate.
Provides customer service to adjusters, providers, and claimants regarding bill review.
Assesses appropriateness and duration of care provided, for possible utilization review.
Recommends 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 material as necessary to perform professional review.
Meets company productivity standards.
Meets company quality standards.

Professional Background:

Certified Professional Coder – a plus but not required

StrataWare software- a plus, but not required

1+ years medical coding experience – CPT, ICD-10 - preferred

1+ years’ experience in Medical Bill Repricing – preferred

SKILLS AND ABILITIES:

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

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 – required

Knowledge of Microsoft Office Products – required

Ability to operate standard office equipment including telephone

PERSONAL CHARACTERISTICS:

Initiative, drive, creativity and persistence

Good organizational skills

Highest professional ethics

Ability to work independently

EEOC STATEMENT:

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

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