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Medical Reviewer
Elara Capital. Maintain productivity, quality, and accuracy targets set by the Governmental Review Manager .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical record review, compliance with regulatory standards, and effective communication with agencies. Proficient in auditing documentation and developing educational tools to enhance clinical practices and prevent revenue loss.
Highest-signal resume keywords
Licensed Practical NurseMedical Record ReviewUtilization ReviewBilling and Coding GuidelinesClinical Documentation
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Medical Record ReviewUtilization ReviewClinical CareDocumentation AuditingRegulatory ComplianceCritical ThinkingRevenue Cycle ManagementOperational Systems EvaluationEducation DevelopmentAppeals Coordination
Soft Skills
CommunicationLeadershipCollaborationProblem-SolvingFollow-Up
Certifications & Qualifications
Licensed Practical NurseLicensed Vocational Nurse
Industry Keywords
Home HealthHospicePatient CarePre-Claim ReviewAgency Leadership
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- 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