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Medical Review Specialist II - 300131

Employer
Noridian Healthcare Solutions
Location
Fargo, ND
Salary
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Industry
Healthcare
Role
Other
Job Type
Long-Term
Hours
Full Time
Job Summary

The Medical Review Specialist (MRS) prepares the medical review workloads by key wording, sorting, and processing correspondence and claims in an accurate and timely manner. The MRS may perform basic claims adjudication, research, inquiry notification, and other support duties.

Key Performance Indicators
  • Strong communication skills
  • Ability to multi-task
  • PC skills including proficiency in Microsoft Office applications


Essential Functions

FLSA Category: Non-Exempt

Key Duties/Responsibilities/Accountabilities
  • Prepares correspondence for workload and distributes to staff for daily completion by key wording, organizing, and sorting documents.
  • Monitors and communicates any aging correspondence requiring completion.
  • Accurately reviews/processes correspondence, inquires, and claims efficiently by following processes.
  • Completes claims processing via the applicable Medicare processing system (Multi-Carrier System (MCS), Fiscal Intermediary Standard System (FISS), or VIPS Medicare System (VMS)).
  • Performs basic adjudication processing.
  • Interprets and resolves the different edits and audits.
  • Recognizes and interprets message codes.
  • Conducts phone calls to providers/suppliers.
  • Tracks and inputs daily production, quality, or attendance data into MME tracking programs.
  • Provides and seeks constructive feedback.
  • Cross-trains in multiple functional activities.
  • Creates system generated and/or manual correspondence to the customers.
  • Adapts to training quickly.
  • Provides guidance to other team members by utilizing creative problem solving skills.
  • Researches and answers questions that are unique and complex.


Non-Essential Duties and Functions
  • Other duties as assigned.
  • Completes call center inquiries as assigned.

Requirements

Qualifications

Minimum Qualifications:

Title: Medical Review Specialist II
  • High school diploma or GED
  • Working knowledge of Medicare operations
  • Strong PC Skills including typing and 10-key skills and Microsoft Office applications (such as Word, Excel, and Access) proficiency
  • Strong written and verbal communication skills
  • Strong research, analysis, and organizational skills
  • Must meet the leveling criteria set forth through meeting and/or exceeding production, quality, values, and behaviors.
  • Advanced PC skills, including proficiency in Microsoft Office applications


Preferred Qualifications:

Above requirements and the following:
  • 1 year Medicare experience


Environment and Cognitive/Physical Demands
  • Office Environment
  • Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
  • Requires prolonged sitting and telephone usage
  • Requires the use of office equipment such as computer terminals, telephones, copiers and printers
  • Infrequent lifting up to 15 pounds
  • Infrequent stooping
  • Click here to enter text as bullet points.


Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to, Segregation of Duties Principles, HIPAA Security and Privacy, CMS requirements, the Noridian Compliance Program, and any other applicable laws, rules and regulations.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description, and may be required to perform any task requested by the supervisor or by management.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency-specific regulations and related clauses included in NHS's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

Other Information

Job Posting Policy 6.05

New employees with Noridian Healthcare Solutions will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@noridian.com.

This job posting will be closed 07/27/2018 at 8:00AM CST. No further applications will be considered.


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