Position Overview
Job Description
Review incoming medical records for completeness, relevance, and quality based on claim requirements
Develop a clinical chronology by organizing records to reflect the progression of diagnosis and treatment
Identify and differentiate diagnostic records from severity-related documentation
Assess medical records for causation support and relevance to the claimed condition
Detect gaps in clinical evidence (e.g., missing records, insufficient documentation, inconsistencies) and escalate with proper rationale
Utilize OCR tools (e.g., Adobe Acrobat) to process scanned documents; flag illegible records for reprocessing
Evaluate physician-issued severity letters to ensure alignment with required clinical standards
Maintain accurate filing and documentation of records within internal systems
Update system fields and ensure all relevant information is ...