Medical Review Analyst I
Company | Elevance Health |
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Location | Norfolk, VA, USA |
Salary | $Not Provided – $Not Provided |
Type | Full-Time |
Degrees | Associate’s |
Experience Level | Mid Level |
Requirements
- Requires a High School Diploma and a minimum of 4 years of internal company claims processing or customer service experience; or any combination of education and experience which would provide an equivalent background.
- Experience with medical coding and medical terminology required.
Responsibilities
- Utilizes guidelines and review tools to analyze assigned medical records and correspondence to route to appropriate imaging and routing applications.
- Follows department guidelines and tools to conduct reviews.
- Reviews, analyzes and renders determinations on assigned Tier I requests.
- Serves as a liaison between medical record management and/or service operations and other internal departments.
- Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
Preferred Qualifications
- Associate degree
- Understanding of provider networks, the medical management process, internal business processes, and proficiency with internal local technology preferred.