Medical Review Specialist

Medlogix, LLC delivers innovative medical claims solutions combining technology, skilled staff, and premier healthcare provider networks to meet client needs efficiently. ReviewWorks, a division of Medlogix based in Northville, Michigan, provides comprehensive medical review, case management, and vocational rehabilitation services to self-insured entities, TPAs, and insurance carriers.

As a Medical Review Specialist, you will review medical bills using your clinical knowledge to determine the relationship of services billed to covered injuries. You'll apply review guidelines, assess medical coding use, identify over-utilization of treatment, and recommend appropriate reimbursements. You will also ensure quality, timeliness, and customer service standards for assigned accounts.

Key responsibilities include reviewing medical bills per policies, determining necessity and relation to injury, advising on reimbursement, providing customer service to adjusters and claimants, assessing care appropriateness, recommending independent medical evaluations when needed, supporting team members, and meeting productivity and quality standards.

Certifications like Certified Professional Coder are a plus but not required. Preferred experience includes 1+ years in medical coding (CPT, ICD-10), medical bill repricing, and Michigan Workers' Compensation.

Required skills include applying clinical knowledge in bill review, proficiency in English, strong communication skills, ability to multitask and problem solve, PC skills including Microsoft Office, and ability to work independently.

This role is full-time, remote (EST timezone).

Medlogix is an Equal Opportunity Employer committed to merit-based employment decisions.