Medical Review Analyst I

Medical Review Analyst I

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.