Virtual Clinical Review Specialist

Job ID: Available for Members

Location: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming

Compensation: To Be Discussed

Staff Reviewed: Thu, Nov 08, 2018

Job Category: Healthcare

Telecommute Level: 100% Telecommute

Travel Requirements: No Travel

Weekly Hours: Full Time

Employer Type: Employer

Career Level: Experienced

Education Level: Some College

Job Summary

A healthcare company is filling a position for a Virtual Clinical Review Specialist.

Individual must be able to fulfill the following responsibilities:

  • Conduct clinical reviews of medical records
  • Process and/or review claims in a timely manner
  • Document clinical review findings within case tracking system

Required Skills:

  • RN required, with related clinical review experience
  • Minimum of 5 years clinical experience
  • Knowledge of medical terminology, CPT-4, and HCPCS coding
  • Working knowledge of coordination of benefits and medical claims processing
  • Strong problem-solving skills
  • Excellent organizational, interpersonal and communication skills