Medlogix

Medical Reviewer

• Reviews medical bills and documentation according to guidelines and RW policies and procedures.
• Determines if treatment is related and necessary to the covered injury.
• Advises reimbursement recommendations are appropriate.
• Provides customer service to adjusters, providers, and claimants regarding bill review.
• Assesses appropriateness and duration of care provided, for possible utilization review.
• Recommends independent medical evaluations (IME) to adjusters when necessary.
• Act as a resource to other staff members to facilitate completion of a quality product.
• Use appropriate reference material as necessary to perform professional review.
• Meets company productivity standards.
• Meets company quality standards.

Medical Review Specialist