Medical Records Review Specialist

Overview

Koya Medical, Inc. is dedicated to revolutionizing venous and lymphatic care through innovative, patient-centered technology. Our team values integrity, humility, dedication, teamwork, and a positive work culture. We offer competitive base salaries with bonus opportunities and comprehensive benefits.

Role Summary

The Medical Records Review Specialist is responsible for verifying that clinical standards are fulfilled to support coverage for the Dayspring Compression Device. This role involves scrutinizing clinical records and formulating detailed medical necessity letters. Candidates should possess strong expertise in medical terminology, diagnoses, treatment procedures, and lymphedema care protocols.

Key Responsibilities

• Conduct meticulous reviews of medical records to ensure compliance with internal medical coverage criteria.
• Compose comprehensive letters of medical necessity derived from clinical notes and medical histories.
• Interpret payer coverage policies, Local Coverage Determinations (LCDs), and National Coverage Determinations (NCDs) accurately.
• Collaborate with field representatives for additional clinical data and provide guidance on guidelines when required.
• Understand and apply health plan requirements to internal payer criteria.
• Maintain thorough knowledge of payer policies and evaluation standards.
• Work alongside internal teams to facilitate timely clinical review decisions.
• Participate in biweekly meetings to discuss complex clinical cases collaboratively.
• Adhere strictly to HIPAA compliance mandates.

Minimum Qualifications

• Experience in drafting Letters of Medical Necessity is essential.
• Bachelor’s degree or equivalent professional experience.
• Previous involvement in the medical device sector, clinical record analysis, or a related domain.
• Advanced familiarity with medical terminology.
• Service-oriented approach and customer focus.
• Proven ability to multitask, prioritize, and manage deadlines independently.
• Solid knowledge of medical policies and LCD guidelines.
• Tech-savvy with ability to use software tools.
• Strong verbal and written communication skills to effectively interact with payers, field personnel, clinicians, colleagues, and management through various communication methods.
• Exceptional attention to detail.

Core Competencies

• Effective communication skills.
• Proficient writing ability.
• Prioritization and time management.
• Ability to build peer relationships.
• Strong problem-solving skills.
• Results-driven initiative.

Tools and Technologies

• Google Suite
• Adobe Software
• Salesforce CRM

Physical Demands and Work Environment

This role requires regular verbal communication and auditory capacity. Frequent use of hands and fingers to handle controls and objects is expected. Occasionally, employees may stand, walk, sit, and extend arms and hands. The role may necessitate lifting or moving up to 25 pounds. Visual requirements include close and distance vision with the ability to adjust focus. The working environment typically has low to moderate noise levels.

Additional Information

The duties outlined do not encompass all responsibilities and may change without notice. The position is subject to reasonable accommodations for disabilities in alignment with ADA requirements. Employment is at-will and does not imply a contract. Koya Medical is an equal opportunity employer and maintains a drug-free workplace.

Compensation

The salary range for this full-time remote position is USD 55,000 annually.