Medical Review Coordinator I

Prime Healthcare•Elgin, IL

1d•Onsite

About The Position

Saint Joseph Hospital - Elgin is seeking a Medical Review Coordinator I to join their team. This role is responsible for coordinating and reviewing medical records, participating in case management and treatment team meetings, and serving as an educator to all departments. The Medical Review Coordinator I will assess patient charts for admission and treatment continuation criteria, gather data for record requests from payers, and communicate the status of accounts for utilization review and case management reporting. The position requires knowledge of federal, state, and intermediary guidelines related to various levels of care and coordination of discharge referrals. The role demands independent work and sound judgment.

Requirements

Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.

Nice To Haves

ECFMG Certification And/or Bachelor’s or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.
Utilization Review experience is highly preferred.
Clinical experience in acute care setting preferred.
Excellent written and verbal communication skills.
Excellent critical thinking skills.
Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.
Ability to work independently in a time-oriented environment.

Responsibilities

Coordinates and reviews all medical records, as assigned to caseload.
Actively participates in Case Management and Treatment Team meetings.
Serves as on-going educator to all departments.
Reviews patient charts to assess whether the criteria for admission and continuation of treatment is being met.
Gathers data and responds to request for records from payers/fiscal intermediary etc.
Gathers clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting.
Able to work independently and use sound judgment.
Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.
Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.
Performs other duties as assigned.