Medical Records Reviewer

Medical Records Reviewer – Exact Billing Solutions (EBS) 
Lauderdale Lakes, FL - On-site

Who We Are 

Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in the substance use disorder, mental health, and autism care fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies. 

EBS is poised for exponential growth, and we are building out our teams to support the expansion of global operations. 

Part of the ICBD family office portfolio, Exact Billing Solutions combines entrepreneurial speed with the financial discipline of a self-funded, founder-led organization. Our growth reflects a proven ability to solve complex healthcare challenges with operational precision, scalable systems, and client-first innovation. 

Our Origin Story 

Exact Billing Solutions was launched to address one of healthcare’s most persistent challenges: the burden of billing and insurance administration on providers. With firsthand knowledge of how inefficiencies in revenue cycle management drain resources from patient care, our founder built a company dedicated to removing obstacles, accelerating cash flow, and delivering peace of mind to clients across specialties. 

Recognition & Awards 

Exact Billing Solutions contributes heavily to the success of the broader ICBD family office ecosystem and benefits from the recognition awarded to other portfolio companies, including: 

• Inc. 5000, 2024 – Top 5 Fastest-Growing Private Companies in America (ABA Centers of America) 

• EY Entrepreneur Of The Year® U.S. Overall 

• Florida Trend Magazine – 500 Most Influential Business Leaders

About the Role

As a Medical Records Reviewer, you will play a pivotal role in ensuring the efficient and effective utilization of healthcare resources.

The Medical Records Reviewer will assist in reviewing and processing records to submit for authorization to the payors. This position collaborates closely with clinical teams, insurance providers, and other healthcare professionals to support efficient and effective patient care.

Requirements

• Review and analyze clinical records, including received documentation from payors, to ensure compliance with ABA therapy best practices and insurance requirements.

• Accurately input and maintain clinical records, authorization requests, and related documents into the electronic health records (EHR) or other relevant systems.
• Assist in tracking and organizing all documentation for utilization reviews, ensuring that all records are complete, accurate, and accessible for audits and reviews.
• Monitor the status of pending authorizations and document updates or changes to treatment plans in a timely manner.

• Assist in processing and reviewing requests for treatment authorization, working with clinicians to verify that all necessary documentation is available for review.
• Assess the appropriateness and necessity of healthcare services, ensuring they align with established guidelines and policies.
• Work closely with interdisciplinary teams, Board Certified Behavior Analysts, Registered Behavior Technicians, and other healthcare professionals to gather insights and ensure comprehensive reviews.
• Assist in preparing records and documentation for external audits or insurance company reviews, ensuring that all necessary information is submitted and compliant with guidelines.
• Identify any discrepancies, missing documentation, or areas where clinical records may require updates to meet the standards.

• Assist in coordinating with insurance providers to obtain authorization and resolve any issues related to service utilization or claims denials.
• Provide requested documentation and supporting materials for authorization and reauthorization requests, ensuring timely submission to insurance companies.
• Maintain records of communications with insurance companies, clinical teams, and other relevant stakeholders.

• Analyze trends in authorization requests, approvals, and denials and provide reports or insights to management to identify areas for process improvement.
• Track utilization patterns, service delivery, and compliance with payer requirements to support continuous improvement in the utilization review process.

• Communicate effectively with team members to ensure the smooth processing of treatment authorizations and timely updates on status or concerns.
• Provi