PRAC Medical Records Review Specialist

SCA Health•Mishawaka, IN

About The Position

The PRAC Medical Records Review Specialist handles complex claim cases, including workers’ compensation, automobile accidents, personal injury, and short- and long-term disability. The role obtains legal documents and medical records, summarizes and organizes records, and prepares materials for physician review. It also prepares IMEs, peer reviews, and record reviews, including recording and summarizing relevant information and delivering physical paperwork to physicians in a timely manner. The specialist uses knowledge of medical terminology, claims, and physician review protocols while maintaining strict confidentiality of medical records and other data. The position also involves professional development to remain current with health care practices and trends, along with other assigned duties. The role requires clear and professional communication with clients, including third-party vendors, attorneys, and insurance companies, and cooperative working relationships with patients, physicians, and staff. The specialist gathers insurance and account information and navigates office computer systems. Work is performed in an office setting with minimal exposure to communicable diseases. It involves extended sitting and computer and phone work, high-speed and accurate task completion, and handling complex, sensitive claim information independently and with discretion.

Requirements

High school diploma or equivalent required.
Minimum cumulative three years of experience in workers’ compensation, medical chart review, and/or medical records.
Ability to communicate clearly and professionally, with excellent phone skills for establishing and maintaining client trust.
Ability to maintain cooperative relationships with patients, physicians, and staff.
Ability to efficiently gather insurance and/or account information.
Ability to navigate and understand computer software systems in an office setting.
Maintain knowledge of clinic and insurance contract policies and procedures, and medical terminology as related to diverse claims.
Ability to sit for up to 8 or more hours per day while entering computer data and responding to phone questions.
Ability to work at high speed with accuracy, view computer screens for long periods, and use a keyboard with manual dexterity.
Ability to perform complex tasks requiring independent judgment and discretion.
Ability to handle difficult and sensitive claims information and interactions with dissatisfied physicians or clients.
Demonstrate current competencies applicable to the job position.

Nice To Haves

Additional certification or related educational experience preferred.
Typing speed of 50 words per minute preferred.

Responsibilities

Manage diverse and complex claim cases, including workers’ compensation, automobile accidents, personal injury, and short- and long-term disability claims.
Obtain legal documents and medical records; summarize, organize, and prepare records for physician review.
Prepare IMEs, peer reviews, and record reviews, including recording, reviewing, and summarizing appropriate information.
Prepare, print, organize, and deliver physical paperwork to physicians in a timely manner.
Use medical terminology to assist clients and physicians.
Maintain strict confidentiality of medical records and other data.
Participate in professional development to stay current with health care practices and trends.
Perform other duties as assigned.