Medical Review Support Representative (Remote/Hybrid Potential)
Christian Healthcare Ministries
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Benefits offered by this job
Job summary
Qualifications
- Prior experience in medical record review or similar role preferred.
- Experience in member communication, particularly phone-based interactions, is desirable.
- Familiarity with regulatory requirements, including HIPAA.
Responsibilities
- Review medical records to assess eligibility for services.
- Analyze documentation for compliance of treatments and procedures.
- Communicate with members regarding inquiries and coverage.
Skills
Job description
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The Medical Review Team at Christian Healthcare Ministries is a dedicated group entrusted with representing the organization's vision and mission, particularly concerning the determination of pre-existing conditions and alternative treatment protocols. Equipped with specialized training under the guidance of the Medical Director, this team continuously updates their insights into traditional medical standards and reviewing medical records.
Their primary responsibility lies in handling the most challenging and complicated memberships while upholding the values and standards of CHM. Additionally, this role involves direct communication with members over the phone to address inquiries, provide information, and resolve concerns.
WHAT WE OFFER
- Compensation based on experience.
- Faith and purpose-based career opportunity!
- Fully paid health benefits
- Retirement and Life Insurance
- 12 paid holidays PLUS birthday
- Lunch is provided DAILY.
- Professional Development
- Paid Training
ESSENTIAL JOB FUNCTIONS
- Review medical records thoroughly to assess the eligibility and appropriateness of provided medical services.
- Analyze medical documentation to determine the necessity and compliance of treatments, procedures, and services.
- Communicate with members via phone to address inquiries, explain medical review processes, and provide guidance on eligibility and coverage.
- Possess effective communication skills to de-escalate tense situations and foster constructive dialogue with members based on eligibility criteria.
- Recognize, research, and maintain accuracy in all assessments and communications.
- Perform literature reviews and research studies to gather relevant data and evidence to support recommended guideline changes.
- Stay abreast of advancements in medical research, evidence-based practices, and regulatory requirements to ensure recommendations are current and relevant.
QUALIFICATIONS
- Collaborate with CHM Leadership, even when differing views arise, to ensure alignment with the organization's goals and objectives.
- Receive direction from the ER-Supervisor and ER-Team to ensure a smooth workflow and efficient resolution of complex cases.
- Communicate openly, honestly, and compassionately with co-workers, members, and staff, delivering information with care and empathy both in writing and over the phone.
- Handle member phone calls with professionalism, ensuring questions are answered and concerns are addressed promptly.
- Maintain strict confidentiality and respect for the privacy of both staff and members in all interactions and discussions.
- Demonstrate unwavering trustworthiness in all actions and decisions, as this role carries significant responsibility.
EXPERIENCE REQUIREMENTS
- Prior experience in medical record review, utilization review, or a similar role within the healthcare industry preferred.
- Experience in member or customer communication, particularly phone-based interactions, is highly desirable.
- Familiarity with regulatory requirements and guidelines of HIPAA regulations.
- Effective communication skills, both verbal and written, with the ability to articulate complex medical information clearly and professionally.
- Detail-oriented approach with a commitment to accuracy and thoroughness in medical record review processes.
- Perform other job duties as assigned by management.
About Christian Healthcare Ministries
Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other’s medical bills. The mission of CHM is to glorify God, show Christian love, and experience God’s presence as Christians share each other’s medical bills.
- Seniority levelAssociate
- Employment typeFull-time
- Job functionCustomer Service
- IndustriesMedical Practices and Hospitals and Health Care
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Medical insurance
401(k)
Paid maternity leave
Paid paternity leave
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Medina, OH $60,000.00-$72,000.00 3 days ago
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