Clinical Reviewer II

The range for this role is $25.00 - $34.13/hour

Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. This role includes opportunity to receive an annual bonus target of 5% of annual eligible earnings. Actual bonus amounts are determined by length of time in role, individual performance, and organizational performance.

Interested candidates must be willing and able to work onsite minimum 4 times per week in either our Melbourne, FL or Orlando, FL office.

The Mission

At Christian Care Ministry we believe that Christians can, and should, share in one another’s burdens. Through the use of Medi-Share, a healthcare sharing ministry for Christians, we cultivate that belief.

The Team

Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren’t perfect people, we are serving our perfect God to the best of our ability.

The Job

The Clinical Reviewer II utilizes clinical expertise for the assessment and evaluation of medical records against proprietary program guidelines and approved evidence-based clinical criteria in conjunction with critical thinking and decision-making skills to conclude sharing determinations based on medical appropriateness of care while maintaining production goals and QA standards. This position will require the ability to work independently, in teams, and in multiple IT systems.

Essential Job Duties & Responsibilities

• Works with leadership, clinical staff, key internal departments, and external customers to ensure optimum clinical outcomes for members
• Organizes, reviews, and interprets members’ medical records and compares them against proprietary program guidelines, CMS and FDA approved policies, and evidenced-based clinical criteria as appropriate to determine eligibility for bill sharing and advocacy for additional programs and interventions; determines if the medical record documentation supports the eligibility of requested and/or billed services
• Completes medical review casework as assigned
• Abstracts review-related data/information accurately and timely in appropriate IT systems
• Provides accurate and timely submission of all administrative and review-related documents to appropriate parties
• Provides appropriate consultation and referral to intra- and interdepartmental resources to ensure members receive optimum services offered by the organization
• Makes case presentations to medical leadership for assistance in making sharing determinations
• Manages assigned clinical caseload
• Delivers accurate and clear verbal and written communication to internal and external customers while complying with organizational HIPAA requirements
• Maintains accurate and timely records of all communications and interventions
• Performs ongoing process improvement for efficiencies and effectiveness
• Performs administrative and clinical processes to ensure team and departmental goals are met
• Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs
• Perform all other duties as assigned
  
  

Essential Skills & Abilities

• Obtain and maintain an expert knowledge of Medi-Share program guidelines and processes
• Strong organizational, prioritization, critical-thinking, and decision-making skills
• Ability to be objective, impartial, and adaptable to change
• Advanced Excel skills and intermediate skills in other Microsoft Office tools (Outlook, Teams, Word)
• Obtain and maintain an advanced knowledge of Salesforce, CSI, and Eldorado use and documentation
• Excellent computer skills – ability to access, research, and use multiple software programs simultaneously for extended periods of time
• Typing speed of at least 35 words per minute adjusted
• Accurate data collection, documentation, and analysis - provide effective and efficient collection and distribution of research data without the need for supervision; able to correlate research findings with solutions
• Excellent ability to communicate effectively in written, oral, telephonic, and digital formats that build collaboration and facilitate positive outcomes
• Ability to work independently and effectively with a team regularly; performs assigned special projects with minimal assistance
• Ability to comply with HIPAA, PHI, and all call compliance rules and regulations
• Excellent ability to provide all content within a biblical framework
  
  

Core Competencies/Demonstrable Behaviors

• Collaborates – builds partnerships and works collaboratively with others to meet objectives. This role requires coordination with administrative support to identify and collect correct medical records in a timely fashion
• Drives Results – consistently achieves review results, even under tough circumstances and tight deadlines
• Thoroughness – ensures information is complete, accurate; remediates errors when identified and applies feedback to avoid future mistakes
• Managing Change – demonstrates support for departmental improvements with positive attitude
• Decisiveness – makes difficult decisions in a timely manner
  
  

Education And/or Experience

• Current unrestricted compact LPN/LVN license with sound knowledge of anatomy and physiology, medical terminology, and disease processes required
• Graduate from an accredited Diploma, Associates Degree, or Bachelor’s Degree Program required, healthcare-related degree preferred
• 2+ years of clinical experience and/or care coordination in an acute or medical-surgical environment required, oncology experience strongly preferred
• 1+ years working with Electronic Medical Records and medical record/abstraction of data required; experience in bill coding and medical record reviews strongly preferred
  
  

Supervisory Responsibilities

• This job has no supervisory responsibilities
  
  

Incentives & Benefits

We work hard to serve our Medi-Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others.

For full-time employees working 30 hours or more, some of our benefits include, but are not limited to:

• 100% paid Medical for employees/99% for family
• Generous employer Health Savings Account (HSA) contributions
• Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
• 6 weeks of paid parental leave (for both mom and dad)
• Dental - two plans to choose from
• Vision
• Short-term Disability
• Accident, Critical Illness, Hospital Indemnity
• 401(k) – up to 4% match on ROTH or Traditional contributions
• Generous paid-time off and 11 paid holidays
• Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo
• Employee Assistance Program including no cost, in-person mental health visits and employee discounts
• Monetary Anniversary Awards Program
• Monetary Birthday Awards