Medical Review Facilitator Job at Federal Hearings And Appeals, Wilkes Barre, PA

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  • Federal Hearings And Appeals
  • Wilkes Barre, PA

Job Description

Job Description

Job Description

  • Maintain a streamlined process for facilitating internal and external medical/peer review requests, including initial case assessment, utilizing applicable utilization management requirements and procedures and guidance from the FHAS Medical Director, as needed. [PRS 2-1.a.i.], [PRS 2-1.a.ii.]
  • Respond to any/all client issues/concerns/complaints as quickly as practical to ensure quick resolution.
  • Act as a liaison between physicians and clients.
  • Review service requests for completeness of information. [PRS 2-2.a.i.]
  • Collect and transfer non-clinical data into FHAS’ case management system . [PRS 2-2.a.ii.]
  • Acquire structured clinical data. [PRS 2-2.a.iii.]
  • Select appropriate medical practitioners and legal professionals to review the cases.
  • Draft case summaries and provide references, as applicable.
  • Confirm all pertinent peer review issues are thoroughly answered.
  • Monitor the reviewers to guarantee there is no conflict of interest and cases are submitted on time.
  • Ensure accuracy and timeliness of decisions.
  • Complete any/all assigned trainings in TalentLMS and SkillPath.
  • Other duties as assigned.

WORK EXPERIENCE REQUIREMENTS

  • Background in healthcare and knowledge of CPT, HCPCS, and ICD-10 codes preferred;
  • Minimum 4+ years of prior experience;
  • Must have strong analytical, verbal, and written communication skills;
  • Excellent organizational skills;
  • Strong presentation, coaching, and facilitation skills;
  • Must be proficient on PC and related software programs including Microsoft Word, Excel, and PowerPoint;
  • Ethical, self-motivated and results oriented team player;
  • Ability to work independently;
  • Travel is not anticipated; however, may be required infrequently.

PHYSICAL REQUIREMENTS

  • Must be able to remain in the stationary position 75% of the time;
  • Occasionally move about inside the office to access cabinets, office machinery, etc. requiring standing, walking, stooping, kneeling or crouching;
  • Constantly operate a computer and other office equipment such as telephone, calculator, copy machine and computer printer;
  • Must be physically able to reach with arms and hands and possess finger and wrist dexterity with repetitive motion for typing and writing;
    • Regular & predictable attendance is essential for this position.
Hybrid Position - 3 days in office/ 2 days remote
Day Shift

Job Tags

Work experience placement, Work at office, Remote work, Day shift,

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