Senior Clinical Reviewer

The range for this role is $73,000 - $99,500

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 applicants 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. To that end, our Mission Statement is as follows: Connecting people to a Christ-centered community wellness experience based on faith, prayer, and personal responsibility.

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 and our Members to the best of our ability.

The Job

The Senior Clinical Reviewer works to summarize and correlate concise, accurate information on medical reviews to determine eligibility of medical bills per the program guidelines. In this role, 70% of the time is spent performing pre-service and post-service medical reviews and/or reviews for high dollar, complex medical cases and collaborating with other departments to optimize cost savings. This position will be expected to make independent decisions regarding timing and omission of medical reviews in deference to other department processes based on the dollar amount of the bill and the Ministry’s cost strategy.

Essential Job Duties & Responsibilities

• Organize and review medical records, lab results, radiology, and pathology reports for conditions ineligible for sharing (CIF’s)
• Determine eligibility of members’ medical bills and/or upcoming procedures/treatments according to the program guidelines 
• Collaborate with other departments to maximize cost savings for individual cases and optimal outcomes for the members
• Appropriately apply the program guidelines to the individual cases reviewed 
• Work autonomously to prioritize and manage workload
• Document effectively in appropriate systems
• Comply with all organizational HIPAA requirements
• Contribute to the exercise and expression of the Ministry’s Christian beliefs
• All other duties as assigned

Essential Skills & Abilities

• Understanding of medical bill processing and provider bill negotiation
• Understand diversity of systems and work flows as they relate to the type of review or assignment
• Able to multitask in multiple operating systems
• Able to work for extended periods of time on the computer
• Proficiency at interpreting medical records and writing detailed reports and conclusions
• Strategic understanding of negotiations, third party processes, bill validation, and care management to determine when to utilize/defer to these processes for active review cases
• Ability to be objective and impartial and conclude a case
• Ability to communicate effectively with both internal and external customers
• Practice good interpersonal skills and work as a member of a team
• Possess the ability to adapt to changing processes
• Working knowledge and application of program guidelines
• Understanding of systems and work flows as they relate to the type of review or assignment
• Ability to utilize the internet including e-mail and search engines
• Word processing skills of at least 25 wpm
• Basic knowledge in Microsoft Office (Excel, Word, Outlook) and ability to use a database system
• Knowledge of document imaging system

Core Competencies/Demonstrable Behaviors

• Collaborates – builds partnerships and works collaboratively with others to meet objectives. This role requires strong interdepartmental understanding and communication.
• Thoroughness – ensures information is complete, accurate; remediates errors when identified and applies feedback to avoid future mistakes.
• Innovation – able to develop and introduce new, improved methods for completing assignments
• Managing Change – demonstrates support for departmental improvements with posit