Medical Reviewer

Job not on LinkedIn

🔥 15 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

👻 Ghost score 25%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Elara Capital

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2002

💼 Consulting

📦 Logistics

📣 Marketing

Consulting • Logistics • Marketing

Elara Capital is a leading global investment and advisory firm, dedicated to providing innovative solutions and expert guidance in the fields of investment banking, securities, and asset management. Founded with a vision to revolutionize the offshore market, Elara Capital has built a reputation for trust and reliability while striving to empower clients in their financial journeys. With a commitment to excellence and a focus on creating a comprehensive financial ecosystem, Elara Capital has raised significant funds for Indian corporates and offers a range of financial services including loans, equity research, and asset management.

📋 Description

• Maintain productivity, quality, and accuracy targets set by the Governmental Review Manager • Promote compliance with regulatory standards through medical record review • Collect, validate, and submit medical records for pre-claim reviews, ADR requests, and appeals • Communicate documentation needs with agencies and follow up with agency leadership • Audit medical record documentation for skilled home health, hospice, and PCS • Communicate compliance findings and documentation deficiencies to management and patient-care personnel • Identify visit documentation that lacks adequate content to support billing guidelines • Help develop strategies and education to prevent revenue loss during recovery audits • Assist with staff education tools and guides for clinical documentation and utilization • Write business letters and reports explaining determinations and decisions to governmental payers, private insurers, and administrative law judges • Participate in all levels of appeals using regulatory guidance and critical thinking • Coordinate and evaluate operational systems to improve efficiency • Provide leadership and support in identifying agency/client needs and improvement opportunities • Report to the Supervisor Pre Claim Review

🎯 Requirements

• High school diploma or GED required • 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 • Prior functional working experience in medical records review, utilization review, or case management preferred • Knowledge of appropriate billing and coding guidelines preferred • Current License as a Licensed Practical Nurse or Licensed Vocational Nurse required

🏖️ Benefits

• Competitive compensation package • Tuition reimbursement for full-time staff • Continuing education opportunities for all employees at no cost • Opportunities for advancement • Comprehensive medical, dental, and vision insurance plans • 401(K) with employer match • Paid time off • Paid holidays • Family bereavement leave • Pet bereavement leave • Pet insurance