Medical Review Coordinator - DMC in Farmers Branch, TX at Dallas Medical Center

Date Posted: 4/8/2018

Job Snapshot

Job Description

Summary:
JOB SUMMARY: 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.

EDUCATION, EXPERIENCE, TRAINING

1. Medical Graduate, Physician Assistant, Nursing Graduate required.
2. ECFMG Certification and/or Bachelor’s or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.
3. Utilization Review experience is highly preferred.
4. Must meet the performance standards set forth by the Hospital/ Department at Medical Review Coordinator position for at least 6 months.
5. 1+ year of clinical experience in acute care setting preferred.
6. 1+ year of experience with ICD-10 and CPT coding in an acute care setting preferred.
7. Experience with use of an encoder software product for code assignment in an acute care setting preferred.
8. Excellent written and verbal communication skills. Excellent critical thinking skills.
9. Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.
10. Ability to work independently in a time-oriented environment.
11.Computer literacy and familiarity with the operation of basic office equipment
12. Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred
   

Work Type: Full Time Employee    

Shift: 1

Legend: Shift 1=Day, 2=Evening, 3=Night, 4=Varied.

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 the Human Resources Department.

EEO is the law poster.