Medical Review Specialist

About the company

Medlogix, LLC provides medical claims solutions by combining its technology platform, experienced team, access to provider networks, and a strong focus on client priorities. Its approach is designed to streamline medical insurance claims handling and improve efficiency for auto insurance and workers’ compensation carriers, TPAs, and government organizations.

ReviewWorks, part of the Medlogix group and established in 1989 in Northville, Michigan, offers medical review, medical case management, and vocational rehabilitation services for self-insured organizations, third-party administrators, and insurance carriers.

Role overview

This full-time, non-exempt position is remote and aligned to the EST time zone. The Medical Review Specialist evaluates medical bills using clinical knowledge and professional judgment to decide whether billed services relate to the covered injury, whether coding has been applied correctly, and whether treatment appears appropriate. The role also carries responsibility for account quality, turnaround time, and customer service.

Core responsibilities

• Examine medical bills and supporting records in line with company policies, procedures, and review guidelines.
• Decide whether treatment is connected to and medically necessary for the covered injury.
• Support appropriate reimbursement decisions based on review findings.
• Respond to questions from adjusters, providers, and claimants about bill review matters.
• Evaluate the appropriateness and length of treatment for possible utilization review.
• Suggest independent medical evaluations (IMEs) to adjusters when needed.
• Serve as a helpful internal resource to support accurate and timely work output.
• Use relevant reference materials to complete professional-level reviews.
• Consistently meet productivity expectations set by the company.
• Maintain company quality standards in all assigned work.

Professional background

Preferred experience and credentials include Certified Professional Coder certification, though it is not mandatory. Prior medical coding experience of at least 1 year with CPT and ICD-10 is preferred, as is 1+ year of medical bill repricing experience. Experience with Michigan workers’ compensation is also preferred.

Skills and abilities

• Ability to use clinical knowledge and/or coding expertise in bill review
• Strong written and spoken English comprehension
• Ability to understand and follow both written and verbal instructions
• Good verbal communication and interpersonal skills
• Capability to manage multiple tasks at once
• Solid problem-solving ability
• Comfortable sitting for extended periods while working at a computer
• Strong PC proficiency
• Working knowledge of Microsoft Office tools
• Ability to operate standard office equipment, including a telephone

Personal characteristics

• Self-starter with drive, initiative, creativity, and persistence
• Well-organized and detail-oriented
• High level of professional ethics
• Ability to work independently

Equal opportunity statement

Medlogix is an equal opportunity employer. Employment decisions are made without regard to race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status, or any other legally protected characteristic.