Medical Records Reviewer II/LPN Melbourne, FL | Orlando, FL | Hybrid The range for this role is $25.00 to $34.13/hr Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. 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 Job The Medical Records Reviewer II utilizes clinical expertise for the assessment and evaluation of medical records against proprietary program guidelines and approved evidence-based clinical criteria in conjunction with critical thinking and decision-making skills to conclude sharing determinations based 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, clinical staff, key internal departments, and external customers to ensure optimum clinical outcomes for members Organizes, reviews, and interprets members’ medical records and compares them against proprietary program guidelines, CMS and FDA approved policies, and evidenced-based clinical criteria as appropriate to determine eligibility for bill 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-related data/information accurately and timely in appropriate IT systems. Provides accurate and timely submission of all administrative and review-related documents to appropriate parties Provides appropriate consultation and referral to intra- and interdepartmental resources to ensure members receive optimum services offered by organization Makes case presentations to medical leadership for assistance in making sharing determinations Manages assigned clinical caseload meeting SLAs Delivers accurate and clear verbal and written communication to internal and external customers while complying with organizational HIPAA requirements Maintains accurate and timely records of all communications and interventions Performs ongoing process improvement for efficiencies and effectiveness Performs administrative and clinical processes to ensure team and departmental goals are met Contributes to the exercise and expression of Christian Care Ministry’s Christian beliefs All other duties as assigned Essential Skills & Abilities Expert knowledge of Medi-Share program guidelines and processes Strong organizational, prioritization, critical-thinking, and decision-making skills Ability to be objective, impartial, and able to adapt to change Advanced Excel skills; intermediate arenaflex office skills (Outlook, Teams, Word) Advanced knowledge of Salesforce, CSI/Eldorado use and documentation Excellent computer skills – ability to access, 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 - provide effective and efficient collection and distribution of research data without the need for supervision; able to correlate research findings with solutions Excellent ability to communicate effectively in written, oral, telephonic, and digital formats that build collaboration and facilitate positive outcomes Ability to work independently and effectively with a team regularly; performs assigned special projects with minimal assistance Ability to comply with HIPAA, PHI, and all call compliance rules and regulations Excellent ability to provide all content within a biblical framework Core 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 timely fashion. Drives Results – consistently achieves review results, even under tough circumstances and tight deadlines Thoroughness – ensures information is complete, accurate; remediates errors when identified and applies feedback to avoid future mistakes. Managing Change – demonstrates support for departmental improvements with positive attitude Decisiveness – makes difficult decisions in a timely manner Education and/or Experience Current unrestricted compact LPN/LVN license with sound knowledge of anatomy and physiology, medical terminology, and disease processes required Graduate from an accredited Diploma, Associates Degree, or Bachelor’s Degree Program required, healthcare-related degree preferred 2+ years of clinical 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/abstraction of data required; experience in bill coding and medical record reviews strongly preferred Must be proficient in arenaflex 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-Share 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% paid Medical for employees/99% for family Generous employer Health Savings Account (HSA) contributions Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance 6 weeks of paid parental leave (for both mom and dad) Dental - two plans to choose from Vision Short-term Disability Accident, Critical Illness, Hospital Indemnity 401(k) – up to 4% match on ROTH or Traditional contributions Generous paid-time off and 11 paid holidays Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo Employee Assistance Program including no arenaflex, in-person mental health visits and employee discounts Monetary Anniversary Awards Program Monetary Birthday Awards Apply tot his job Apply tot his job Apply tot his job