Review the case and the medical records on file to identify any missing information.
When unavailable, obtain medical records contacts, phone numbers, and fax numbers for physician’s office.
Submit requests for medical records to the MD office and follow up on those requests per client guidelines.
Request test results from client if not on file.
Submit medical records to the insurance company or provide records to be filed with an appeal.
Comply with all Medical Records Needed – CLM and Medical Records Needed – Appeal worklist process, system, and documentation SOPs (Standard Operating Procedure).
Meet worklist and follow-up time requirements to complete assigned worklist tasks promptly.
Send an appropriate letter to the payer when all available records have been sent, and the claim / appeal is still pending.
Participate in team meetings by sharing the details of cases worked.
Ability to meet predetermined Productivity Goals based on the level of Appeal.
Ability to meet Quality Standard in place (90% or greater)
Other duties as assigned.
Education / Experience :
High School diploma or GED
Previous experience working with and interpreting medical records documents
Detail oriented and ability to multitask
Ability to maintain confidentiality
Possess excellent written and verbal communication skills
Ability to establish priorities, work independently, and proceed with objectives without supervision
Proficient in using Microsoft Excel and Word
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Medical Specialist • Cleveland, OH, US
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