MEDICAL REVIEW SPECIALIST

Job Description

MEDICAL REVIEW SPECIALIST

Location: Rockford, IL

Work Environment: Remote


Pay rate: 25.00 per hour

Schedule: Monday-Friday, 8:00 AM-4:30 PM CST

POSITION SUMMARY


The Medical Review Specialist is responsible for reviewing medical records, provider billing, claims, and related documentation for accuracy, completeness, appropriate coding, and compliance with established medical, billing, and client guidelines.


This position requires strong attention to detail, knowledge of medical coding and reimbursement practices, excellent documentation skills, and the ability to identify and resolve discrepancies. The Medical Review Specialist will work independently in a remote environment while maintaining strict compliance with HIPAA, legal requirements, safety standards, and client-specific guidelines.

KEY RESPONSIBILITIES

• Create accurate and detailed reports based on medical records, documentation, and applicable medical guidelines.
• Analyze provider billing for appropriate coding and adherence to billing guidelines across various provider types.
• Review claims for completeness, accuracy, consistency, and compliance with industry standards and client requirements.
• Review medical records and supporting documentation to identify missing, inconsistent, or inaccurate information.
• Contact clients to resolve questions, discrepancies, inconsistencies, or missing information.
• Perform quality assurance reviews before reports and assignments are finalized.
• Ensure medical records, reports, and supporting documentation are accurately maintained and stored for audit purposes.
• Respond to client inquiries regarding report status, documentation, and review information.
• Maintain accurate records while protecting confidential patient and client information.
• Follow HIPAA requirements, company policies, safety standards, and applicable federal and state regulations.
• Promote the efficient and appropriate use of company resources.
• Notify management of issues, process updates, client profile changes, or other concerns requiring attention.
• Maintain productivity and accuracy while working independently in a remote environment.

REQUIRED QUALIFICATIONS

Education & Certifications

• CCP or CPC-A certification required.
• Knowledge of medical billing and medical coding practices.
• Knowledge of CPT coding guidelines and ICD-10 classification.
• Knowledge of CMS reimbursement guidelines .
• Understanding of fee schedules, medical review processes, and provider billing practices.
• Knowledge of HIPAA regulations and healthcare privacy requirements.

Meet Your Recruiter

Alexis Wordlaw-Conley


About Rockford, IL


Ready to take your career to new heights in Rockford, Illinois? Explore our job opportunities in this vibrant city and uncover endless possibilities for growth and success. Nestled in the heart of Winnebago County, Rockford blends urban convenience with a laid-back Midwest charm. From iconic landmarks like the Anderson Japanese Gardens and the Coronado Performing Arts Center to the mouth-watering cuisine at Beef-A-Roo and the exciting games hosted by the Rockford IceHogs at the BMO Harris Bank Center, this city has something for everyone. The Rockford region boasts a thriving arts scene, with galleries like the Rockford Art Museum and the Klehm Arboretum & Botanic Garden providing inspiration at every turn. Discover your next career move in Rockford, where opportunities abound and a unique culture awaits!


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