Christian Healthcare Ministries
Medical Review Specialist
Christian Healthcare Ministries, Barberton, Ohio, United States, 44203
Be among the first applicants for a Medical Review Specialist role at Christian Healthcare Ministries (CHM). The Medical Review Team reviews, analyzes, and interprets medical documentation to ensure accuracy, compliance, and alignment with CHM’s eligibility guidelines. Team members work under the guidance of the Medical Director to stay current with traditional medical standards and medical record reviews, and collaborate with members and staff to uphold CHM’s mission and values.
Responsibilities
Review medical records thoroughly to assess eligibility and the appropriateness of medical services provided. Analyze medical documentation to determine necessity, compliance, and alignment with CHM guidelines. Conduct literature reviews and research to support evidence-based recommendations. Stay abreast of medical research, industry trends, and regulatory changes to maintain current and relevant recommendations. Communicate effectively with members with compassion and professionalism, de-escalating tense situations when needed. Collaborate with CHM leadership, the Eligibility Review Supervisor, and the Medical Director to ensure consistency in decision-making. Maintain strict confidentiality and safeguard all protected health information (PHI) in compliance with HIPAA and CHM policies. Perform other job duties as assigned by management. Qualifications & Competencies
Strong analytical and critical thinking skills with the ability to interpret complex medical documentation. Effective written and verbal communication with the ability to explain complex medical information clearly and with empathy. Strong organizational skills with the ability to prioritize multiple cases and meet deadlines. Proficiency in Microsoft Office Suite and ability to learn internal CHM systems and databases. Collaborative spirit with the ability to work effectively within a team while upholding CHM’s mission. Demonstrated integrity, trustworthiness, and commitment to CHM’s values. Experience Requirements
Prior experience in medical record review, utilization review, or related healthcare role preferred. Familiarity with HIPAA regulations and compliance standards. Experience with medical coding, health information systems, or EMR/EHR platforms is a plus. Strong attention to detail and commitment to accuracy in all review processes. Performance Expectations
Complete reviews accurately and within established timelines. Maintain confidentiality, professionalism, and compliance with CHM policies. Ensure positive interactions with members and staff through clear, compassionate communication. Support CHM’s mission and organizational goals through collaborative problem-solving and member-focused service. Work Schedule and Environment
Standard hours: Monday–Friday, 9:00 AM – 5:00 PM Hybrid work potential after successful training and demonstration of performance standards. Work is primarily sedentary, involving extensive computer-based review and communication. Physical & Environmental Requirements
Ability to remain in a stationary position for long periods while reviewing medical records. Frequent use of computer, keyboard, and office equipment. Occasional lifting of up to 20 pounds (e.g., files or records). Professional office environment with moderate noise levels. About Christian Healthcare Ministries
Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other’s medical bills. The mission of CHM is to glorify God, show Christian love, and experience God’s presence as Christians share each other’s medical bills.
#J-18808-Ljbffr
Review medical records thoroughly to assess eligibility and the appropriateness of medical services provided. Analyze medical documentation to determine necessity, compliance, and alignment with CHM guidelines. Conduct literature reviews and research to support evidence-based recommendations. Stay abreast of medical research, industry trends, and regulatory changes to maintain current and relevant recommendations. Communicate effectively with members with compassion and professionalism, de-escalating tense situations when needed. Collaborate with CHM leadership, the Eligibility Review Supervisor, and the Medical Director to ensure consistency in decision-making. Maintain strict confidentiality and safeguard all protected health information (PHI) in compliance with HIPAA and CHM policies. Perform other job duties as assigned by management. Qualifications & Competencies
Strong analytical and critical thinking skills with the ability to interpret complex medical documentation. Effective written and verbal communication with the ability to explain complex medical information clearly and with empathy. Strong organizational skills with the ability to prioritize multiple cases and meet deadlines. Proficiency in Microsoft Office Suite and ability to learn internal CHM systems and databases. Collaborative spirit with the ability to work effectively within a team while upholding CHM’s mission. Demonstrated integrity, trustworthiness, and commitment to CHM’s values. Experience Requirements
Prior experience in medical record review, utilization review, or related healthcare role preferred. Familiarity with HIPAA regulations and compliance standards. Experience with medical coding, health information systems, or EMR/EHR platforms is a plus. Strong attention to detail and commitment to accuracy in all review processes. Performance Expectations
Complete reviews accurately and within established timelines. Maintain confidentiality, professionalism, and compliance with CHM policies. Ensure positive interactions with members and staff through clear, compassionate communication. Support CHM’s mission and organizational goals through collaborative problem-solving and member-focused service. Work Schedule and Environment
Standard hours: Monday–Friday, 9:00 AM – 5:00 PM Hybrid work potential after successful training and demonstration of performance standards. Work is primarily sedentary, involving extensive computer-based review and communication. Physical & Environmental Requirements
Ability to remain in a stationary position for long periods while reviewing medical records. Frequent use of computer, keyboard, and office equipment. Occasional lifting of up to 20 pounds (e.g., files or records). Professional office environment with moderate noise levels. About Christian Healthcare Ministries
Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other’s medical bills. The mission of CHM is to glorify God, show Christian love, and experience God’s presence as Christians share each other’s medical bills.
#J-18808-Ljbffr