Job Description

Job Description

Job Description

Key Responsibilities:

• Review the case and the medical records on file to identify any missing information.
• When unavailable, obtain medical records contacts, phone numbers, and fax numbers for physician’s office.
• Submit requests for medical records to the MD office and follow up on those requests per client guidelines.
• Request test results from client if not on file.
• Submit medical records to the insurance company or provide records to be filed with an appeal.
• Comply with all Medical Records Needed – CLM and Medical Records Needed – Appeal worklist process, system, and documentation SOPs (Standard Operating Procedure).
• Meet worklist and follow-up time requirements to complete assigned worklist tasks promptly.
• Send an appropriate letter to the payer when all available records have been sent, and the claim/appeal is still pending.
• Participate in team meetings by sharing the details of cases worked.
• Ability to meet predetermined Productivity Goals based on the level of Appeal.
• Ability to meet Quality Standard in place (90% or greater)
• Other duties as assigned.

Education/Experience:

• High School diploma or GED
• Previous experience working with and interpreting medical records documents
• Detail oriented and ability to multitask
• Ability to maintain confidentiality
• Possess excellent written and verbal communication skills
• Ability to establish priorities, work independently, and proceed with objectives without supervision
• Proficient in using Microsoft Excel and Word

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