Medical Reviewer

Payrate: $40.00- $43.00/hr.


Summary:
The main function of a Medical Reviewer is to ensure accuracy and compliance of healthcare documentation and information to confirm they meet regulatory standards.


Responsibilities:

• Perform medical record abstraction & enter findings into Database.
• Identify Pursuit Opportunities & Track progress.
• Call provider offices & hospitals to request medical records.
• Call members to identify date & provider of HEDIS service.
• Data enters call results in Pursuit Database.
• Coordinate with Collector and manage caseload.
• Communicate with team members to effectively manage project assignments.

Skills:

• Verbal and written communication skills, multi-tasking, customer service skills and interpersonal skills.
• Strong ability to work independently and manage one's time.
• Strong ability to keep information organized and confidential.
• Must be proficient with access-like databases and conduct most/all work activities on computer only.

Qualifications:

• High school diploma or GED required
• 8-10 years' experience
• Strong medical (can be a RN, LVN etc.) & auditing background

Pay Transparency: The typical base pay for this role across the U.S. is: $40.00- $43.00/hour . Non-exempt positions are eligible for overtime at a rate of 1.5 times the base hourly rate for all hours worked in excess of 40 in a work week, or as required by state or local law. Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education and experience. Full-time employees are eligible to select from different benefits packages. Packages may include medical, denmatch, lifeion benefits, health savings accounts with qualified medical plan enrollment, 10 paid days off, 3 days paid bereavement leave, 401(k) plan participation with employer match, life and disability insurance, commuter benefits, dependent care flexible spending account, accident insurance, critical illness insurance, hospital indemnity insurance, accommodations and reimbursement for work travel, and discretionary performance or recognition bonus. Sick leave and mobile phone reimbursement provided based on state or local law.


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