Clinical Reviewer

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Clinical 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.

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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.

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How to Apply:

Apply online at https://www.viemed.com/company-information/#careers 

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