Medical Records Review Specialist
Koya is always looking for curious and passionate individuals who want to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun. We offer a base + bonus compensation package, and a competitive benefits program.
Description
Description
The Medical Records Review Specialist is responsible for reviewing clinical documentation and drafting letters of medical necessity. Key elements include a comprehensive understanding of medical terminology, diagnosis, procedures and treatment protocols to properly assess medical documentation for required internal criteria and NCD. This position will report to Manager of Prior Authorizations in the Payer Operations department. The role is full-time, exempt and will work remotely.
Essential Duties and Responsibilities
The essential functions include, but are not limited to the following:
● Ability to carefully review medical records to establish if internal guidelines are met to ensure medical coverage for the device
● Draft letters of medical necessity based on clinical findings obtained from office notes and medical history forms
● Communicate effectively with internal teams when more clinical information needed to substantiate medical need
● Understand health plan requirements to know if a plan of care is needed
● Work with internal departments to ensure timely review and approval of clinical documentation received
● Review benefit investigations to see if a plan of care is required for Medicare Advantage plans
● Participate in biweekly triage meetings with multiple team members to discuss complex clinical cases
● Effectively educate field reps on medical necessity requirements
Minimum Qualifications
●Bachelor’s degree or equivalent work experience; Previous experience in the medical device industry or related field
Knowledge, Skills and Abilities
● Strong level of proficiency with medical terminology
● Proven ability to work independently, multitask, and prioritize to meet required deadlines
● Working knowledge and expertise of medical policy and NCD
● Technology savvy
● Ability to work independently and in collaboration with a team
● Able to provide clear and concise communication to paers, field representatives, clinicians, peers, and management via telephone, email, video conference and/or in person
● Strong verbal and written communication skills
● High attention to detail
Core Competencies
● Communication
● Writing proficiency
● Priority setting
● Time management
● Critical thinking
● Problem solving
● Collaboration and teamwork
● Drive for results
Tools and Technology
G Suite, Microsoft Office Suite, Adobe, Salesforce CRM
Physical Functions and Work Environment
The physical functions described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.
While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand;
walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.
Note
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any Koya manager authorized to provide instruction or assign work. Duties, responsibilities, and activities may change at any time with or without notice.
All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.
Koya Medical, Inc. is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
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