Medical Review Specialist [Aplicar en 3 Minutos]...

Job Title : Medical Review Specialist

Job Description

As a Medical Review Specialist, you will play a crucial role in reviewing admissions and service requests to determine medical necessity and compliance with reimbursement policies.

You will collaborate with physicians and healthcare teams to ensure appropriate documentation, case justification, and discharge planning.

Key Responsibilities :

• Review and assess medical records to determine the appropriateness of treatment and services.
• Collaborate with healthcare teams to ensure accurate and timely communication.
• Identify and address potential denials and appeals.
• Support denial resolution processes and ensure all communications with payors are properly documented and escalated when needed.
• Communicate effectively with third-party payors, physicians, patients / families, and internal stakeholders.

Required Skills and Qualifications :

Benefits

Our organization offers competitive remuneration, annual performance-based bonus, and standard industry benefits.

As a Medical Review Specialist, you will have opportunities for professional growth and development in a dynamic and supportive environment.