Medical Review Coordinator- FT in Harlingen, TX at Harlingen Medical Center

Date Posted: 8/15/2019

Job Snapshot

  • Employee Type:
  • Location:
    5501 U.S. 77
    Harlingen, TX
  • Job Type:
  • Experience:
    At least 1 year(s)
  • Date Posted:

Job Description


Coordinates and completes the clinical reviews for all patient medical records while working closely with CMO (Chief Medical Officer). Actively participates in the Case management and UR meetings. Serves as on-going educator to all departments.  Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from payers/fiscal intermediary etc.; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Works with health information management staff, coding staff, physicians, financial services, onsite and remote utilization review teams with regards to admission criteria, medical necessity, payment denials, and documentation issues. 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.



Requisite skills to float to a variety of clinical areas, assess clinical criteria of all new patients for admission and performs utilization review and preauthorization as well as concurrent clinical authorization and reviews.Reviews admissions within 24 hours excluding holidays and weekends and prepares for daily Case Management meetings.Reviews inpatient medical records for identified payor populations (i.e., Medicare, etc.) as directed on admission and throughout hospitalization. Analyzes clinical status of patient, current treatment plan and past medical history and ensure that utilization reviews are performed as required.Responsible for documentation feedback to RN’s, Social Service employees, Unit Staff, Director of Nursing, Physicians, and Department Administration at Corporate.Reviews payor information and perform utilization reviews as necessary for admission authorization and approval for continuation of treatment. Completes and submits authorization requests in a timely manner as requested.Enters all authorizations and status of accounts into the hospital-wide tracking system.Maintains active file of denials and reports status as requested.Assists in preparing accounts for the appeal process by tracking deadlines, reviewing clinical information, writing appeal requests generating and submitting new TAR’s.Assists tracking appeal status of accounts.Facilitates the appropriate clinical documentation to ensure that the intensity of services and level of acuity of the patient is accurately reflected in the medical record. Ensures abnormal findings are addressed, and the patient’s past medical history of conditions is appropriately documented.Fosters respect for privacy by maintaining confidentiality in all phases of the work.On an ongoing basis educates all members of the patient care team on documentation guidelines. Devices educational materials to inform medical staff and nursing staff regarding to update on the clinical documentation requirements.Actively participates and assists Performance Improvement Department in improving clinical documentation for compliance in quality of care measures (esp. Medicare CORE Measures) for specific charts.Works with health information management staff, coding staff, physicians, financial services, onsite and remote utilization review teams with regards to admission criteria, medical necessity, payment denials, and documentation issues. Instructs staff on proper documentation in the medical record.Assists as needed, for New Employee Orientation.Assists and provides as needed documentation education of staff members to maintain or improve level of documentation.Copies and mails/faxed requested records to Intermediary, out of county Medi-Cal/Medicaid  patients and Third Party requests. Maintains current CMS regulations.Functions and collaborates with readmission reduction team goalsAll other duties as assigned or requested.


Medical Graduate, Physician Assistant, Nursing Graduate required. 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.Must meet the performance standards set forth by the Hospital/ Department at Medical Review Coordinator position for at least 6 months.1+ year of clinical experience in acute care setting preferred.1+ year of experience with ICD-10 and CPT coding in an acute care setting preferred.Experience with use of an encoder software product for code assignment in an 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.Computer literacy and familiarity with the operation of basic office equipmentComputer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred


We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics.  If you need special accommodation for the application process, please contact Human Resources.  EEO is the Law: