12 Oct
The Legal Base
Vijayawada
Job Title: Medical Review Specialist
Company: The Legal Base
About Us : The Legal Base is a dynamic and forward-thinking ALSP (Alternate Legal Service Provider) dedicated to providing exceptional legal outsourced services to our US and Canada based clients. We are seeking a detail-oriented and experienced Medical Review Specialist to join our team.
Job Summary: The Medical Review Specialist is responsible for conducting comprehensive reviews of medical records, claims, and clinical documentation. This role involves ensuring the accuracy and completeness of medical records, evaluating claims for compliance with policies, and supporting the organization in maintaining high standards of quality and regulatory compliance.
The ideal candidate has a strong understanding of medical terminology, healthcare regulations, and clinical practices.
Key Responsibilities:
- Review and analyze medical records , claims, and clinical documentation to ensure accuracy, completeness, and compliance with healthcare regulations.
- Evaluate claims and medical records for consistency with policies, procedures, and regulatory requirements.
- Identify discrepancies, errors, or inconsistencies in documentation and communicate findings to the appropriate parties.
- Prepare detailed reports and summaries based on medical record reviews, highlighting key findings and recommendations.
- Collaborate with healthcare providers, insurance representatives, and legal professionals to provide insights and support regarding medical records.
- Ensure compliance with HIPAA and other applicable laws and regulations regarding patient information and medical records.
- Stay up-to-date with industry standards, medical guidelines,
and regulatory changes that may impact the review process.
- Assist in the development and implementation of quality assurance and improvement initiatives within the review process.
Qualifications:
- Bachelor’s degree in Nursing, Health Information Management, or a related field. Advanced degrees or certifications (e.g., RHIA, RHIT, CCS, or CPC) are a plus.
- Minimum of 4 years of experience in medical record review , clinical documentation, or a related field.
- Proficiency in handling mass tort cases .
- Strong knowledge of medical terminology, ICD-10, CPT coding, and healthcare regulations.
- Familiarity with HIPAA regulations and compliance standards.
- Excellent analytical skills with a keen eye for detail and accuracy.
- Strong written and verbal communication skills.
- Proficiency in using electronic health records (EHR) systems and medical review software.
- Ability to work independently and manage multiple tasks effectively.
Preferred Skills:
- Experience in working with healthcare providers, insurance companies, or legal firms.
- Familiarity with Medicare and Medicaid regulations.
- Knowledge of medical billing and reimbursement processes.
How to Apply: Interested candidates are invited to submit their resume and a brief cover letter explaining their relevant experience and why they are a suitable fit for the Medical Review Specialist role at TLB. Please send applications to , including "Medical Review Specialist Application - (Your Name)" in the subject line.
We look forward to reviewing your application.
TLB is an equal opportunity employer. We encourage applications from candidates of all backgrounds and experiences.
Note: This job description is intended to provide a general overview of the responsibilities and qualifications for the position of Medical Review Specialist . It is not an exhaustive list of duties, and responsibilities may evolve to meet the needs of the company.
▶️ Medical Review Specialist
🖊️ The Legal Base
📍 Vijayawada