Job Description
CMA/Clinical Reviewer needed for busy medical practice in Myrtle Beach. Must have excellent computer and customer service skills. Hours are Monday through Thursdays 7:45am - 5:15pm and Fridays 8am - 12pm. No nights or weekends! Excellent pay and benefits including paid holidays, PTO and sick time, medical, dental, vision, short-term disability, company paid life insurance, pre-paid legal, identity theft, and 401k offered.
GENERAL SUMMARY OF DUTIES:
When ancillary or lab services are ordered by providers but do not meet the “medically necessary” requirements per insurance guidelines, the CMA/Clinical Reviewer will review the patient’s chart to ensure that all information is accurate and look for other diagnosis’ alternatives to support the orders being medically necessary. The CMA will contact the provider to review the encounter/order. If appropriate and approved by the provider, CMA may amend the order and/or encounter on behalf of the provider to reflect the updated diagnosis and send to the provider to sign off and approve.
This position will also be reviewing service schedules (Ultrasound, Dexa Scan, etc.) prior to the scheduled appointments to ensure that appropriate guidelines and approvals have been met for the services before they are rendered to ensure that the claims will be accepted and paid quickly by payers.
ESSENTIAL FUNCTIONS
GENERAL DUTIES:
KNOWLEDGE:
SKILLS:
ABILITIES:
REQUIREMENTS:
ENVIRONMENTAL/WORKING CONDITIONS:
Combination of office and remote work.
PHYSICAL/MENTAL DEMANDS :
Varied activities include sitting, walking, stooping, lifting, bending, and reaching. Occasional stress from workload. Must be able to use a variety of office equipment including phone, writing instruments, PC, fax.
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