Our client, a leading healthcare organization dedicated to improving member and provider experiences, is seeking a Medical Review Support Analyst I to support clinical review and claims audit processes. In this role, you will assist in the triage and review of claims, coordinate medical record requests, and ensure accurate documentation and communication across internal teams and provider partners. This position plays a key role in ensuring claims selected for review are processed efficiently, records are properly obtained and analyzed, and regulatory and quality standards are maintained.
Contract Duration: 6 -Months
Work Model: 100% Remote (Preference for candidates who reside OR, WA, ID, or UT)
Pay: $20.00 – 23.87/hr., DOE
Benefits Eligibility: Yes
Schedule:
Must be able to work PST hours
May require availability for evenings, weekends, holidays, and overtime as needed
Responsibilities of the Medical Review Support Analyst I:
- Perform triage on claims selected for review to determine whether they meet clinical review or audit criteria.
- Prepare and send medical record request letters to providers and obtain records through EMR systems when available.
- Receive, research, and process incoming medical records submitted via fax, mail, email, or secure upload.
- Review claim history and pre-authorization determinations as needed to support the audit process.
- Input claim processing instructions and relevant updates into the Facets system and communicate claim status with designated claims staff.
- Maintain accurate documentation, required fields, and detailed notes within department databases.
- Send notification letters to providers and coordinate with Network Management regarding missing or incomplete records.
- Ensure all work meets production goals and quality standards while complying with regulatory and accreditation requirements.
- Support department efficiency through flexibility and cross-training on additional operational functions.
Qualifications of the Medical Review Support Analyst I:- High school diploma or GED.
- 3+ years of experience in a healthcare environment such as a medical office, claims processing, billing, or customer service, or an equivalent combination of education and experience.
- Strong written and verbal communication skills.
- Experience working with medical records, claims, or healthcare documentation.
- Proficiency with medical terminology and healthcare processes.
- Strong organizational, analytical, and problem-solving skills with the ability to work independently and meet deadlines.
- Experience using Facets or similar claims systems.
- Knowledge of medical anatomy, coding, or healthcare billing processes.
- Familiarity with BlueCard, ITS processes, FEP Direct, or Salesforce.
