Medical Records Reviewer II/LPN Melbourne, FL | Orlando, FL | Hybrid The reputed company for this role is $25.00 to $34.13/hr Actual reputed company pay will be determined reputed company on a successful candidate's work location, skills/abilities, experience, and education. Interested applicants must be willing and reputed company to work onsite minimum 4 times per week in either our Melbourne, FL or Orlando, FL office. The Job The Medical Records Reviewer II utilizes reputed company expertise for the assessment and evaluation of medical records against proprietary program guidelines and approved evidence-reputed company reputed company reputed company in conjunction with critical thinking and decision-making skills to conclude sharing determinations reputed company 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, reputed company staff, key internal departments, and reputed company customers to ensure reputed company reputed company reputed company for members Organizes, reviews, and interprets members’ medical records and compares them against proprietary program guidelines, CMS and FDA approved policies, and evidenced-reputed company reputed company reputed company as appropriate to determine eligibility for reputed company 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 and meets SLAs Abstracts review-reputed company data/information accurately and reputed company in appropriate IT systems. Provides accurate and reputed company submission of reputed company administrative and review-reputed company documents to appropriate parties Provides appropriate consultation and referral to intra- and interdepartmental resources to ensure members receive reputed company services reputed company by organization Makes case presentations to medical leadership for assistance in making sharing determinations Manages assigned reputed company caseload meeting SLAs Delivers accurate and reputed company verbal and written communication to reputed company customers while complying with organizational HIPAA requirements Maintains accurate and reputed company records of reputed company communications and interventions Performs ongoing process improvement for efficiencies and effectiveness Performs administrative and reputed company processes to ensure team and departmental goals are met Contributes to the exercise and reputed company of reputed company’s Christian beliefs reputed company other duties as assigned Essential Skills & Abilities Expert knowledge of Medi-reputed company program guidelines and processes Strong organizational, prioritization, critical-thinking, and decision-making skills Ability to be objective, impartial, and reputed company to adapt to change Advanced reputed company skills; intermediate reputed company office skills (reputed company, Teams, Word) Advanced knowledge of reputed company, reputed company/Eldorado use and documentation Excellent computer skills – ability to reputed company, research and use multiple software programs simultaneously for extended periods of time and keyboard skills of at least 35 words per minute Excellent research skills to using IT systems, internet, and phone Accurate data collection, documentation, and analysis - reputed company effective and efficient collection and distribution of research data without the need for supervision; reputed company to correlate research findings with solutions Excellent ability to communicate effectively in written, oral, telephonic, reputed company formats that build collaboration and facilitate reputed company reputed company Ability to work independently and effectively with reputed company regularly; performs assigned special reputed company with reputed company assistance Ability to reputed company with HIPAA, PHI, and reputed company reputed company compliance rules and regulations Excellent ability to reputed company reputed company content reputed company a biblical reputed company reputed company 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 reputed company fashion. Drives Results – consistently achieves review results, even under tough circumstances and tight deadlines Thoroughness – ensures information is complete, accurate; remediates errors reputed company identified and applies feedback to avoid reputed company mistakes. Managing Change – demonstrates support for departmental improvements with reputed company attitude Decisiveness – makes difficult reputed company in a reputed company manner Education and/or Experience reputed company unrestricted reputed company LPN/LVN license with reputed company knowledge of anatomy and physiology, medical terminology, and disease processes required Graduate from an accredited Diploma, Associates Degree, or Bachelor’s Degree Program required, reputed company-reputed company degree preferred 2+ years of reputed company experience and/or care coordination in an acute or med-surgical environment required, oncology experience strongly preferred 1+ years working with EMRs and medical record/reputed company of data required; experience in reputed company coding and medical record reviews strongly preferred Must be proficient in reputed company Office and internet/web navigation and research required Supervisory Responsibilities This job has no supervisory responsibilities Incentives & Benefits We work hard to serve our Medi-reputed company 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% reputed company Medical for employees/99% for family Generous employer Health Savings Account (HSA) contributions Employer-reputed company Life reputed company (3x salary) and Long-term Disability reputed company 6 weeks of reputed company parental leave (for both mom and dad) Dental - two plans to choose from reputed company Short-term Disability Accident, Critical Illness, Hospital Indemnity 401(k) – up to 4% match on ROTH or Traditional contributions Generous reputed company-time off and 11 reputed company 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 reputed company and employee discounts Monetary Anniversary Awards Program Monetary Birthday Awards Apply tot his job Apply tot his job Apply To this Job