Position Description Medical Systems is a service company made up of friendly, energetic employees who go above and beyond to provide exceptional customer service. Customer loyalty is our top priority, and our employees are committed to building unique relationships in a fast-paced team environment. Medical Systems encourages a positive, supportive, and open culture which rewards employee accountability and grants empowerment for all members of our team. Our commitment to diversity guarantees we employ the best.
The Documentation Specialist is responsible for ensuring medical and/or psychological review reports are of the highest quality and integrity and in full compliance with federal and state mandates. This position has frequent interaction with doctors, claims handlers, attorneys and paralegals both on the phone and through email to resolve issues which may arise during the course of reviewing these reports. Strong proofreading and editing skills are required to ensure an error free report, containing a continuity of opinions throughout and adherence to the appropriate permanency guidelines.
The Documentation Specialist is instrumental in positioning Medical Systems to successfully meet the needs of customers and will work in a highly collaborative environment with other employees to ensure our clients receive the highest quality report in a timely fashion.
Performs quality assurance analysis (proofreading and editing) of medical or psychological review reports.
Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
Determines that all client instructions and specifications have been followed and that all questions have been addressed.
Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
Confirms all federal and/or state mandates are adhered to at all times.
Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
Identifies possible inconsistencies within the report and contacts the Medical Reviewer to obtain clarification as needed.
Assists in resolution of customer complaints and quality assurance issues as needed.
Provides insight and direction to management on consultant quality, availability, and compliance with client specifications.
Promotes effective and efficient utilization of company resources.
Participates in various educational and training activities as required.
Performs other duties as assigned.
Required Skills SPECIAL SKILLS/KNOWLEDGE/ABILITIES
Candidate must be self-motivated with professional attitude with proven experience in accomplishing goals within a team oriented environment.
Excellent interpersonal skills required with the ability to communicate with a diverse range of people
Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
Ability to respond appropriately and professionally to all inquiries or complaints from clients, physicians, upper management, regulatory agencies, and/or members of the business community.
Ability to read, analyze and interpret common correspondence, medical records, itemized billing statements and legal contracts and documents.
Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
Must possess excellent skills in English usage, grammar, punctuation, and style.
Must be a qualified typist with a minimum of 40 W.P.M.
Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
Demonstrates accuracy and thoroughness, striving to improve and promote quality and monitors own work to ensure quality is met.
Must be able to maintain confidentiality.
Must be able to work well under pressure and or stressful conditions.
Must possess the ability to manage change, delays, or unexpected events appropriately.
Required Experience BACKGROUND REQUIREMENTS
A Bachelor’s degree in English, Writing, or Journalism preferred. An Associate’s degree in Technical Writing, Paralegal Certificate or Degree accepted. Knowledge of the insurance industry, preferably in claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability is a plus. Excellent verbal and written communication skills.