Online Proofreading Jobs Remote Medical Review Analyst

Responsibilities of the Medical Review Analyst:

• Analyze records and utilize clinical experience to determine pre-existing, medical necessity, benefit eligibility and/or appropriate reimbursement for claims and/or products.
• Responsible for identifying, documenting, and escalating system and process issues. If issues arise, determine root cause and recommend solutions and complete correction.
• Review claims submitted by medical personnel and members by utilizing clinical knowledge. Determine medical necessity or treatment and refer cases accordingly.
• Monitor billing and document inappropriate usage or utilization trends.
• Maintain communication for members and providers about the status of their claims and medical reasoning behind decisions.

Qualifications of the Medical Review Analyst:

• RN/LPN North Carolina (NC) license
• Strong computer skills
• 3+ years of hands on clinical experience
• Medical billing experience preferred, but not required

Compensation of the Medical Review Analyst:

• Salary: based on relevant experience
• Comprehensive Benefits: Cigna Healthcare, MetLife Dental, VSP Vision, 401K