Diagnostic Radiology- Medical Record Reviewer
Blank StreetSalary not specified
Full Time
Expert & Leadership (9+ years)
Not SpecifiedCompensation
Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
- Bachelor's degree or equivalent work experience
- 4-6 years of clinical nursing or therapy experience
- Active RN, OT, or PT license
- Willing to work additional or irregular hours as needed
- Must work in accordance with applicable security policies and procedures to safeguard company and client information
- Must be able to sit and view a computer screen for extended periods of time
Responsibilities
- Review appeals submitted by members, providers, or authorized representatives related to denied authorizations, level of care determinations or coverage issues
- Classify appeals accurately once received
- Ensure each appeal meets regulatory, contractual and organizational filing requirements
- Meet the required turnaround times to submit appeal packages to the QIO
- Ensure compliance with federal, state, and accreditation standards, and identify opportunities to enhance communication or processes
- Participate in team meetings, educational activities, and interrater reliability testing to maintain review consistency and professional growth
- Perform other job duties as assigned
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
Is this position remote?
Yes, this is a remote position.
What qualifications are required for this role?
Required qualifications include a Bachelor's degree or equivalent work experience, 4-6 years of clinical nursing or therapy experience, and an active RN, OT, or PT license.
What is the salary for this position?
This information is not specified in the job description.
What is the company culture like at WellSky?
WellSky fosters an authentic culture where independent thinking and collaboration come together, thriving on innovation, inclusiveness, and cohesive perspectives.
What makes a strong candidate for this role?
Strong candidates will have the required Bachelor's degree or equivalent, 4-6 years of clinical experience with an active RN, OT, or PT license, plus preferred experience in utilization review, case management, managed care regulations, and tools like MCG Guidelines or InterQual.
WellSky
Healthcare software and community care solutions
About WellSky
WellSky offers software and services to improve health and community care, making it easier for providers and patients to access and navigate care. Its products, like the WellSky Value Based Care Suite, integrate with Electronic Health Record (EHR) systems to enhance care coordination. WellSky stands out by providing a comprehensive range of solutions, including strategic consulting and revenue cycle management, which help clients operate more efficiently. The company's goal is to enhance care delivery and improve individuals' quality of life through effective solutions.
Reston, VirginiaHeadquarters
1980Year Founded
$34.5MTotal Funding
DEBTCompany Stage
Social Impact, HealthcareIndustries
1,001-5,000Employees