Medical Records Review Specialist

Description

Koya Medical, a privately held company founded in 2018, is a transformative healthcare company developing breakthrough treatments for venous diseases and lymphedema to enable joint contractions, patient mobility, and personalized care that is unavailable with traditional compression therapy.

Join Our Team

Koya is always looking for curious and passionate individuals who want to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun. We offer a base + bonus compensation package, and a competitive benefits program.

Job Summary

The Medical Records Review Specialist plays a crucial role in ensuring clinical criteria is met for the Dayspring Compression Device. This individual will review and analyze clinical documentation and draft letters of medical necessity to support the need for the Dayspring. The ideal candidate will have a strong understanding of medical terminology, diagnoses, procedures, and lymphedema treatment protocols.

Job Description REV DATE

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:

• Thoroughly review medical records to determine if internal guidelines and requirements are met for medical coverage.
• Draft comprehensive letters of medical necessity based on clinical findings from office notes and medical history forms.
• Ability to read and understand payer coverage policies, LCDs, and NCDs
• Effectively communicate with the field representatives to obtain additional clinical information and provide education on guidelines when needed.
• Understand health plan requirements to determine internal requirements for payer.
• Must have knowledge of payer guidelines and criteria
• Collaborate with internal departments to ensure timely review and approval or denial of clinical documentation.
• Participate in biweekly triage meetings to discuss complex clinical cases with team members.
• Follow all HIPAA requirements
  
  

Minimum Qualifications

Education, Experience and Training

• Must have experience drafting Letters of Medical Necessity.
• Bachelor’s degree or equivalent work experience
• Previous experience in the medical device industry, clinical record review, or related field.
  
  

Knowledge, Skills, And Abilities

• Strong level of proficiency with medical terminology
• Service oriented
• Proven ability to work independently, multitask, prioritize and meet required deadlines
• Working knowledge and expertise of medical policy and LCD
• Technology savvy
• Ability to work independently and in collaboration with a team
• Able to provide clear and concise communication to payers, field reps, clinicians, peers and management via phone, email, video conference and/or in person
• Strong verbal and written communications skills
• High attention to detail
  
  

Core Competencies

• Communication
• Writing Proficiency
• Priority Setting
• Peer Relationships
• Problem Solving
• Time Management
• Drive for Results
  
  

Tools and Technology

Google Suite, Adobe, Salesforce CRM

Physical Functions and Work Environment

The physical functions described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with

Disabilities To Perform The Functions.

While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.

Note

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any Koya manager authorized to provide instruction or assign work. Duties, responsibilities, and activities may change at any time with or without notice.

All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.