Medical Report Analyst

Overview

Do you have hands-on experience reviewing medical reports and claims?

If you answered yes, then this might be the job for you.

MES in Rocky Hill, CT is looking for a Medical Report Analyst (internally known as Quality Assurance Coordinator) to join our team.  You will be responsible for reading medical reports ensuring accuracy by searching for any errors in grammar, medical terminology, and content before sending to our clients. 

This role is ONSITE, full time position with a standard Monday-Friday 8:00-5:00pm work schedule.

Responsibilities

• Performs quality assurance review of IME reports, correspondences, addendums or supplemental reviews.
• Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
• Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
• Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
• Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
• Ensures the provider credentials and signature are adhered to the final report.
• Identifies any inconsistencies within the report and contacts the Provider to obtain clarification, modification or correction as needed.
• Assists in resolution of customer complaints and quality assurance issues as needed.
• Ensures all federal ERISA and/or state mandates are adhered to at all times.

Qualifications

Medical Report Analyst's come from all different backgrounds including medical assistant, paralegal, English majors, transcription, insurance and legal field and more!

• High school diploma or equivalent required.
• Two years IME experience preferred.
• Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability preferred.
• Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must possess excellent skills in English usage, grammar, punctuation and style.
• Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Must be able to maintain confidentiality.

ABOUT US: 

MES Solutions, a respected pioneer of the independent medical examination (IME) and peer review services industry, is setting the standard for independent review services nationwide. We handle evaluations for a variety of property and casualty insurers, self-insureds and third-party administrator’s business lines such as: automotive, disability, liability, group health, long-term care, FMLA and workers' compensation.  IME and Peer Review services play an important role in evaluating the appropriateness, medical necessity, cost, as well as certification of requests for care.  IME services and Peer Review services are provided by MES Solutions, accredited by URAC for CORE Organizational Quality, and MES Peer Review Services, a URAC accredited Comprehensive Independent Review Organization,­ respectively. 

MES is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

MES offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.