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About the Role

Responsible for managing and providing divisional support to all Medical Records Unit (MRU) activities, including medical record requests, receipts, research, and tracking through the medical record database. This role involves researching Facets and Plan Connexion processing systems and controlling workflow to ensure timely handling of intakes and meeting performance metrics.

Responsibilities

• Perform quality assurance for all internal and external medical record requests and determine appropriate outgoing communication.
• Review medical record receipts for completeness and determine appropriate workflow.
• Extract data from Facets and/or Plan Connexion systems to prepare medical record reports.
• Process and maintain current and accurate Department of Labor medical record requests.
• Assist Claim Examiners with inquiries.
• Participate in learning opportunities regarding regulations, systems, procedures, and skills.
• Maintain high standards of integrity, supporting the company’s mission and values.
• Uphold member privacy in accordance with corporate policies.
• Resolve escalated organizational requests and inquiries (Level II).
• Identify trends, determine root causes, and recommend solutions (Level II).
• Research, track, and resolve Department of Labor medical record requests (Level II).
• Resolve all types of medical record review transactions, including Host and Local claims (Level II).
• Observe and escalate inventory level fluctuations (Level II).
• Train Level I employees on department processes (Level II).
• Resolve medical record review transactions, including Host, Home, and Local claims (Level III).
• Communicate risk to leadership and initiate action for resolution (Level III).
• Mentor and train on lines of business within MRU (Level III).
• Support analytical work (Level III).
• Serve as subject matter expert for testing new system implementations and improvements (Level III).
• Identify, recommend, and initiate process and desk level documentation improvements (Level III).
• Provide productional support to areas outside of MRU (Level III).
• Participate as subject matter expert in project and process improvement work for MRU (Level III).
• Maintain the Medical Record Database (Level III).
• Monitor inventory fluctuations to coordinate, delegate, and execute inventory control/assignment plans (Level III).
• Coordinate invoicing for medical record payments (Level III).
• Learn and support areas outside of MRU (Level III).
• Provide resolution for complex and escalated issues (Level III).

Requirements

• High school diploma or equivalent required.
• Office experience and claims background preferred.
• Basic computer skills required, including navigation in a Windows environment and ability to work between multiple programs simultaneously.
• Strong self-management skills, including reasoning, problem-solving, change management, communication, time management, and organizational skills.
• Ability to meet minimum performance metrics.
• Ability to arrive at work on time and as scheduled.
• Ability to analyze data and identify trends (Level II).
• Ability to mentor and train (Level II).
• Exceed performance expectations for a minimum of one year and/or meet performance expectations for three years as a Level I (Level II).
• Demonstrated in-depth knowledge of and ability to coach/support MRU on all lines of business and other areas within Claims (Level III).
• Exceed performance expectations for a minimum of three years and/or meet performance expectations for five years (Level III).
• Ability to hear, understand, and speak clearly while using a phone.
• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse, and/or phone for three or more hours at a time.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

Skills

• Medical record requests
• Medical record receipts
• Medical record research
• Medical record tracking
• Medical record database management
• Facets processing system
• Plan Connexion processing system
• Workflow control
• Quality assurance
• Data extraction
• Department of Labor medical record requests
• Computer skills
• Windows environment navigation
• Multi-tasking between applications
• Reasoning
• Problem-solving
• Change management
• Communication
• Time management
• Organizational skills
• Data analysis
• Trend identification
• Mentoring
• Training
• Coaching
• Subject matter expertise

Location

• Remote work may be possible on a case-by-case basis

Work Type

• Full-time

Experience Level

• Level I
• Level II
• Level III

Education Level

• High school diploma or equivalent

Salary/Compensations

• Level I: $20.00 - $24.43
• Level II: $20.40 - $27.00
• Level III: $20.80 - $30.80

Benefits

• Participation in group health and/or dental insurance
• Retirement plan
• Wellness program
• Paid time away from work
• Paid holidays

About the Company

• The Lifetime Healthcare Companies

Equal Opportunity

• All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.