Clinical Review Specialist - Contract! (40 Hrs./Week)

Myomo, Inc.; Mississippi; Remote; USD 10,000 - 60,000; Full time

Job summary

A leading company is seeking a Clinical Review Specialist to manage patient caseloads and ensure accurate clinical documentation for insurance purposes. The ideal candidate will have a graduate degree in a relevant field and experience in patient care or health insurance. Strong communication and organizational skills are essential for success in this fast-paced remote role.

Qualifications

• 1-3 years of direct patient care experience required.
• Well-versed in medical terminology and comfortable with medical records.

Responsibilities

• Maintain and monitor patient caseload, adhering to insurance deadlines.
• Review patient medical records to establish medical necessity.

Skills

Communication

Organization

Attention to Detail

Education

Graduate degree from an accredited physician assistant, nursing, occupational therapy or physical therapy program

Tools

MS Office

Gmail

Adobe

EMR systems

Job description

Clinical Review Specialist - Contract! (40 Hrs./Week)

Department: Medical Affairs

Employment Type: Contract

Location: Remote, U.S.

Compensation: $35.00 - $40.00 / hour

Description

The core function of the Clinical Appeals Specialist (CAS) role is to compose a cohesive clinical prior authorization request with supporting medical documentation for Myomo products, ultimately supporting the establishment of medical necessity.

The ideal candidate is highly detailed and self-organized with strong communication skills across multiple modes. He/she understands the gravity and importance of both accurate and complete clinical documentation, brings former background with the insurance ecosystem, and maintains a disciplined follow-up cadence.

Responsibilities

• Maintain and monitor patient caseload, adhering to insurance deadlines.
• Review patient medical records in order to establish medical necessity for Myomo products.
• Review policy, crafting a written appeal in response to insurer-specific denials.
• Audit payer policies, updating resources ad hoc.
• Ensure alignment and strategic processes through intra/interdepartmental communications.
• Develop and update ongoing resources collaboratively with management, regarding insurance policies, operational strategies, and analysis of authorization/denial trends.
• Meet with manager regularly as needed, sharing key updates and metrics.
• Attend department and company meetings as scheduled; assist in training new staff if needed.
• Meet productivity expectations as outlined in performance goals.

Requirements

• Graduate degree from an accredited physician assistant, nursing, occupational therapy or physical therapy program required.
• At least 1-3 years of direct patient care experience in a hospital or outpatient setting with
  patients who commonly suffer upper extremity weakness as a result of illness/injury OR previous background in health insurance, medical device, biotechnology, or a pharmaceutical policy environment.
• Well-versed in medical terminology; comfortable reading and interpreting medical records from various medical specialties and/or allied health professionals.
• Comfortable with common computer programs including MS Office, Gmail, Adobe, & EMR systems.
• Excellent written/verbal, interpersonal, and organizational skills with strong attention to detail.
• Comfortable in a fast-paced setting with the ability to prioritize and adapt amid an evolving environment.
• Ability to meet deadlines with specified time constraints, planning tasks and work accordingly.
• Ability to work well both independently as well as collaboratively in a team environment.