BackClinical Reviewer
@ VieMed
Essential Duties and Responsibilities:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.
- Performs a variety of systems administration and support tasks.
- Function as a clinical reviewer to inspect clinical records for the presence of documentation to support the validity of claims data submitted.
- Discern when missing medical record gaps exist and assist in directing request for additional records.
- Collaborates with peers and leadership
- Provides recommendations for action based on reviews of medical records with proper therapy.
- Monitor’s healthcare documents to ensure compliance before submitting to insurance companies. Checking medical records for appropriate criteria.
- Understand and comply with all governmental, regulatory and Viemed intake, billing and compliance regulations/policies including but not limited to Medicare and Medicaid programs
- Documents in computer system the status of referral
- Reports all concerns or issues directly to Intake Manager or Intake Supervisor
- Other responsibilities and projects as assigned.
Qualifications:
Qualifications
- Current Professional medical license. (RN, LPN, RT, etc)
- One (1) to two (2) years working for a Durable Medical Equipment company or relevant medical office experience preferred.
- Basic understandings of medical insurance benefits
- Skill in establishing and maintaining effective working relationships with other employees, patients, organizations, and the public.
- Effectively communicate with physicians, patients, insurers, colleagues, and staff
- Able to read and understand medical documentation effectively.
- Knowledge and understanding of same and similar DME equipment.
- Thorough understanding and maintaining of medical insurances company’s regulations and requirements to include but not limited to Medicare and Medicaid.
- Learns and maintains knowledge of current patient database.
- Up to date with health information technologies and applications
- Answers telephone in a polite and professional manner. Communicates information to appropriate personnel and management in a timely manner.
- Establishes and maintains effective communication and good working relationships with co-workers, patients, organizations, and the public.
- Proficient in Microsoft Office, including Outlook, Word, and Excel
- Utilizes initiative, strives to maintain steady level of productivity and is self-motivated.
- Work week is Monday through Friday and candidates will work an agreed upon shift.
- Possible weekend work or overtime, to include working an on-call rotation schedule.
Access to Protected Health Information (PHI)
- This position will require the employee to handle Protected Health Information (PHI) for duties related to document and report preparation.
- Policies and procedures will be strictly adhered to make sure PHI is protected as required by the HIPAA Privacy Rule.
How to Apply:
Apply online at https://www.viemed.com/company-information/#careers
Visit Site to Apply
Location: Lafayette, LA
Date Posted: May 10, 2023
Application Deadline: June 12, 2023
Job Type: Full-time