Medical Review Specialist

3 days ago


Knoxville, Tennessee, United States ADDICTION AND MENTAL HEALTH SERVICES, LLC Full time
Job Overview

Addiction and Mental Health Services, LLC seeks a skilled Medical Review Specialist to join our team.

Estimated Salary:

$65,000 - $85,000 per year, depending on experience.

Job Description

We are looking for a highly organized and detail-oriented individual to coordinate the facilities insurance certification process, including precertification and continued stay reviews. The successful candidate will also be responsible for following up on all insurance denials, appeals, and reconsiderations.

Responsibilities
  • Perform pre-admission certification reviews, continued stay reviews, appeals, denials, and reconsiderations, and provide information to the appropriate review agency or insurance company.
  • Maintain an accurate 'UR Activity Log' that records every review for the facility with financial classification and U.R. information/activity.
  • Manage a 'call back' calendar for continued stay reviews and maintain a U.R. file for each patient.
  • Document reviews in the patient electronic record software, including the level of care requested, status, outcome, and next review information.
  • Review and maintain all correspondence pertaining to certification, appeals, denials, or reconsiderations, and ensure they are scanned into the patient electronic health record.
  • Complete Quality Improvement indicators for Utilization Management, data analysis, and reporting.
  • Educate counseling staff on documenting patient care and educate crisis staff on managed care criteria.
Requirements
  • A current RN, LPC, LMFT, LMSW, or LCSW license is preferred.
  • Two years minimum experience in utilization review is preferred.
  • Good grammatical and communication skills are essential.
  • Skill in Microsoft Office applications and basic knowledge of office equipment are required.


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