Therapy Services Reviewer — Remote & Flexible Hours

Elevance Health; Mason (OH); Remote; USD 60,000 - 85,000; Full time

Job summary

Elevance Health seeks a Reviewer - Therapy Services to review medical records for therapy services (PT/OT/SLP) to determine medical necessity and proper filing. The role supports virtual full-time work with required in-person training and adheres to hybrid/virtual work policy.

Responsibilities include processing authorizations, documenting findings, consulting with clinical reviewers, and serving as a resource for internal and external customers.

Qualifications

• Graduate from a PT/OT/SLP program or a 2-year PTA/OTA/SLP assistant program with at least 1 year of clinical experience.
• Current active unrestricted license or certification in the applicable field within the state.
• Licensure/certification appropriate to field of specialty is required.

Responsibilities

• Review medical records to determine if therapy services were medically necessary and properly filed.
• Process system generated authorization decisions meeting contract requirements and unit goals.
• Document findings, develop analyses, and submit reports per government regulations.
• Research and obtain additional data, consult with clinical reviewers and medical directors when necessary.
• Act as a resource for internal and external customers.
• May participate in intradepartmental projects and initiatives.
• Maintain quality and productivity standards and ensure reviews are timely.

Skills

Clinical experience

Education

College-level PT/OT/SLP program or 2-year PTA/OTA/SLP program

Job description

Elevance Health seeks a Reviewer - Therapy Services to review medical records for therapy services (PT/OT/SLP) to determine medical necessity and proper filing. The role supports virtual full-time work with required in-person training and adheres to hybrid/virtual work policy.

Responsibilities include processing authorizations, documenting findings, consulting with clinical reviewers, and serving as a resource for internal and external customers.