Job

Medical Review Specialist (Remote)

Location Remote, CA 0
Date Posted December 18, 2020
Job ID 7021
Employment Type Direct Hire

Scion Nonprofit Staffing (www.scionnonprofitstaffing.com) has been engaged to conduct a search for a Remote Medical Review Specialist for our client, a well-known health care provider with an inspiring impactful mission based out of Southern California. This is a fully remote, direct-hire opportunity with an immediate need!
 
Overview
The Medical Review Specialist will work closely to review all contracted and non-contracted providers for the claims department that require review of medical necessity and/or pricing of non-contracting providers. This position requires an individual has the ability to work autonomously and collaborate with team members.
 
The Perks
-Fantastic team with an amazing company culture!
-Direct-hire opportunity with an immediate need!
-Fully remote opportunity!
-A competitive salary depending on experience level!
-A fast paced environment that will motivate you daily!
 
What You’ll Be Doing
  • Processing medical and dental claims.
  • Processing medical claims for UABT/self-funded groups.
  • Answering questions regarding claims, eligibility, and benefit information.
  • Collaborating with Benefit Plan Administrator, Legal, and Reinsurance departments regarding claim issues.
  • Developing reports for Legal on charges related to subrogation claims.
  • Maintaining appeals spreadsheet for Legal.
  • Assisting with benefit determination.
  • Reviewing accumulator history and correction of claims.
  • Packaging claims for medical review.
  • Preparing reports for the Claims Manager.
     
What You Need to Be Successful
  • Extensive experience related to medical adjudication, case management, and/or CMS.
  • Exceptional knowledge of medical and dental terminology.
  • Previous experience with medical and dental claims payment.
  • Knowledge of CPT/CRVS/RBRVS coding and ground rules. Additional knowledge of iCD9 coding, ERISA, and self-funding arrangements a plus.
  • CMS and/ or MediCare knowledge.
  • Ability to think outside of the box to creatively approach obstacles.
  • Adaptability, a high level of organizational skills, and attention to detail.
  • Strong written and verbal communication skills.
     
Compensation
A rewarding career and generous salary depending on experience plus a full and robust benefits package including health, dental, vision, disability, retirement with a 100% employer match up to 5% of your annual salary, and a generous amount of paid time off plus all major holidays.
 
How to Apply
For immediate consideration, please submit your resume and cover letter here: https://www.scionstaffing.com/job/7021
 
About Our Search Firm
Scion Staffing is a top temporary staffing agency and executive search firm, connecting leading companies and organizations with impeccable talent. Through our innovative team-building and staffing solutions, we bridge the gap in temporary staffing, as well as contract-to-hire employment, contingent search, and executive searches. The Business Times has recognized us as a top staffing from 2010-2019, and our clients return to us for a variety of opportunities.
Scion Staffing is an equal opportunity employer and service provider and does not discriminate on the basis of race, religion, gender, age, gender identity, national origin, citizenship status, sexual orientation, disability, political affiliation or belief, or any other protected class. We are committed to the principles of Equal Opportunity Employment and are dedicated to making employment decisions based on merit and value, for ourselves, our client companies, and for the candidates we represent.
 
 

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