Medical Reviewer

Elara Caring•Dallas, TX

10h•Onsite

About The Position

At Elara Caring, we have a unique opportunity to play a huge role in the growth of an entire home care industry. Here, each employee has the chance to make a real difference by carrying out our mission every day. Join our elite team of healthcare professionals, providing the Right Care, at the Right Time, in the Right Place. At Elara Caring, we care where you are and believe the best place for your care is where you live. We know there’s no place like home, and that’s why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting. Wherever our patients call home and wherever they are on their journey of health, we care. Each team member has a part to play in this mission. This means you have countless ways to make a difference as a Medical Reviewer. Being a part of something this great starts by carrying out our mission every day through your true calling: developing an amazing team of compassionate and dedicated healthcare providers. To continue to be an industry pioneer in delivering unparalleled care, we need a Medical Reviewer with commitment and compassion. Are you one of them? If so, apply today!

Requirements

Requires a high school diploma or GED.
Graduated with a diploma from an accredited school as a Licensed Practical Nurse or Licensed Vocational Nurse.
Minimum of three (3) years of experience as a licensed practical nurse or licensed vocational nurse in a home health and/or hospice clinical care setting is required.
Current License as a Licensed Practical Nurse or Licensed Vocational Nurse is required.

Nice To Haves

Prior functional working experience in medical records review arena (Utilization Review, Case Management and knowledge of appropriate billing and coding guidelines) is preferred.

Responsibilities

Maintains productivity, quality and accuracy targets set by the Governmental Review Manager
Promotes compliance with all regulatory standards, through review of medical records.
Collects appropriate medical records, reviews the documentation for validity, and submits the requested documents for pre-claim reviews, ADR requests, and/or appeals.
Communicates with agencies related to documentation needs in a timely manner and follows up with agency leadership, as needed.
Conducts audits of medical record documentation for skilled home health, hospice and PCS as needed to ensure documentation adequacy.
Communicates significant findings, problems, and changes related to compliance with documentation standards to the Governmental Review Manager and other personnel involved with patient care.
Identifies and communicates to the Governmental Review Manager and other supervisory personnel visit documentation that lacks adequate content to support billing guidelines.
Participates in the development of strategies/education to prevent loss of revenue during recovery audits.
Assists with development of staff education tools/guides to promote appropriate clinical documentation and utilization.
Writes business letters and reports to explain determinations and decisions to a variety of audiences, including, but not limited to governmental payers, private insurance providers, and administrative law judges.
Participates in all levels of appeal as needed, using regulatory guidance and critical thinking to navigate appeals compliantly.
Promotes, coordinates, and evaluates operational Systems to enhance operations and promote efficiencies.
Provides leadership to team and support staff in identifying agency/client needs and opportunities for improvement.