Medical Specialist - MBRU

It’s a great time to join AAA The Auto Club Group! 

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Job Type:

Full time

 

Exempt/Non Exempt:

 

Salary

Job Description:

 

Medical Specialist– The Auto Club Group

What you will do:

• The Auto Club Group is seeking prospective Medical Specialist who will review medical documentation on billing software to determine appropriateness of medical care as it relates to automobile accidents. 

In this position, you will have the opportunity to:

• Identifies and coordinates customers' access to medical services, including alternative care options. 
• Interacts with physicians and other medical personnel to ensure appropriateness and medical necessity of treatment, length of stay and use of ancillary services. 
• Ensures treatment is reasonably necessary for an injured person's care, recovery or rehabilitation as defined by Michigan No Fault Act.
• Reviews and monitors the insured's medical records/bills for complete, timely and accurate entries. Consults with physicians of multiple specialties as well as other health professionals regarding bill dispute resolution. 
• Works closely with claim representatives and serves as a resource for claims staff by providing medical direction on claims. 
• Gathers and analyzes data and reports in order to identify discrepancies, trends or issues. 
• Provides technical assistance to clinical and administrative staff regarding the development of quality improvement indicators/monitors and measurement methodology. 
• Conducts special studies and prepares report on findings.

With our powerful brand and the mentoring, we offer, you will find your position as a Medical Specialist can lead to a rewarding career at our growing organization.

How you will benefit:

A Medical Specialist will earn a competitive salary of $70,000 - $75,000 annually; with annual bonus potential based on performance

• Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include:
• 401k Match
• Medical
• Dental
• Vision
• PTO
• Paid Holidays
• Tuition Reimbursement

We’re looking for candidates who (Preferred/Required Qualifications):

Required Qualifications (these are the minimum requirements to qualify)

Education (include minimum education and any licensing/certifications):

• Associate’s degree in nursing with licensure in State of Michigan as a Registered Nurse
• Possession of a valid driver's license

Experience:

• quality assurance/utilization review
• monitoring medical records to assess and evaluate utilization of services, quality of care, and identification of potential risk factors
• conducting special studies/analyses and summarizing findings in report form
• research statistics and quality improvement methodologies

Knowledge and Skills:

Knowledge of:

• injury rehabilitation techniques
• utilization review and quality assurance standards and programs through reading and attendance at seminars and involvement in professional organizations
• personal computers, including word processing spreadsheet and database software packages
• CPT and ICD-9 coding

Ability to:

• provide education and technical information to staff regarding utilization review and company standard medical protocols and changes
• work effectively with customers
• communicate effectively with others in a work environment, other professionals and health care providers, and with the public
• gather and analyze data and reports, identify discrepancies, problems or issues and recommend action plans based on findings
• analyze complex reports and information related to and resulting from quality reviews
• utilize computer systems
• work with a team on individual claims to ensure appropriateness of treatment
• Strong written and oral communication skills.
• Must reside in the state of Michigan

Preferred Qualifications

Education:

• Bachelor's degree in nursing

Work Environment

This position is currently able to work remotely from a home office location for day-to-day operations unless occa