Remote Medical Specialist – The Auto Club Group

What you will do:

Reviews medical documentation on billing software to determine appropriateness of medical care as it relates to automobile accident. Identifies and coordinates customers' access to medical services, including alternative care options. Interacts with physicians and other medical personnel to ensure appropriateness and medical necessity of treatment, length of stay and use of ancillary services. Ensures treatment is reasonably necessary for an injured person's care, recovery or rehabilitation as defined by Michigan No Fault Act. Reviews and monitors the insured's medical records/bills for complete, timely and accurate entries. Consults with physicians of multiple specialties as well as other health professionals regarding bill dispute resolution. Works closely with claim representatives and serves as a resource for claims staff by providing medical direction on claims.

Gathers and analyzes data and reports in order to identify discrepancies, trends or issues. Provides technical assistance to clinical and administrative staff regarding the development of quality improvement indicators/monitors and measurement methodology. Conducts special studies and prepares report on findings.

How you will benefit:

Medical Specialists will earn a competitive salary of $53,000 to $71,000 annually with annual bonus potential based on performance.

• Excellent and comprehensive benefits packages are just another reason to work for the Auto Club Group. Benefits include:
• 401k Match
• Medical
• Dental
• Vision
• PTO
• Paid Holidays
• Tuition Reimbursement

We’re looking for candidates who:

Preferred Qualifications

Education

• Bachelor’s degree in Nursing with licensure in State of Michigan as a Registered Nurse.

Required Qualifications:

Education

• Associate’s degree in Nursing with licensure in State of Michigan (or state of residence) as a Registered Nurse.
• Possession of a valid driver's license.

Experience

3 years of experience in:

• Quality assurance/utilization review
• Monitoring medical records to assess and evaluate utilization of services, quality of care, and identification of potential risk factors
• Conducting special studies/analyses and summarizing findings in report form
• Research statistics and quality improvement methodologies

Knowledge of:

• Injury rehabilitation techniques
• Utilization review and quality assurance standards and programs through reading and attendance at seminars and involvement in professional organizations
• Personal computers, including word processing spreadsheet and database software packages
• CPT and ICD-9 coding

Ability to:

• Provide education and technical information to staff regarding utilization review and company standard medical protocols and changes
• Work effectively with customers
• Communicate effectively with others in a work environment, other professionals and health care providers, and with the public
• Gather and analyze data and reports, identify discrepancies, problems or issues and recommend action plans based on findings
• Analyze complex reports and information related to and resulting from quality reviews
• Utilize computer systems
• Work with a team on individual claims to ensure appropriateness of treatment
• Strong written and oral communication skills.

What it’s like to work for us:

We serve our members by making their satisfaction our highest priority. We do what’s right by sustaining an open, honest and ethical work environment. We lead in everything we do by offering best-in-class products, benefits and services. And we value our employees by seeking the best talent, rewarding high performance and holding ourselves accountable.

All in all, we create an inclusive and welcoming environment of diverse backgrounds, experiences and viewpoints, realizing our differences make us stronger.

Who we are:

The Auto Club Group helps AAA Members enjoy life’s journey with peace of mind by providing innovative solutions, advocacy and membership benefits wherever and whenever they need them. We currently conduct business in 14 states in the upper Midwest and the Southeast.

The Auto Club Group has established four long-term enterprise goals:

• Long-term, sustainable, profitable growth
• AAA Membership growth and renewal
• Operational excellence
• Become the “flagship club” of the AAA Federation

Important Note:

ACG’s Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.

The above statements describe the principle and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfil these requirements.

The Auto Club Group, and all of its affiliated companies, is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

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