Last active: 28 days ago
I have been in the Healthcare and Insurance Industry for four years. I started as a medical reviewer for different doctors and hospital facilities under the Workers Compensation in the United States. The Workers Compensation is a form of insurance which provide medical reimbursement for injured workers.
As a medical reviewer, my task is to review the injured workers ‘ medical-legal files and prepare reports as well as deposition summaries for physicians. Those medical reports are used by physician in evaluating the patient’s medical history and condition. Some of the reports and deposition are used in court proceedings. After the review of the patient’s medical records, the patient’s claim form will be submitted to the insurance company for review if the patient’s condition is medically necessary and if it’s covered under the policy.
In 2011, I started working as a medical claims reviewer for one of America’s largest insurance writer company. My task is to review claim forms submitted by medical professionals and hospital facilities to determine the mode of reimbursement and to ensure accuracy and integrity of customer accounts through adherence to all established business rules, state mandated fee schedules and usual and customary guidelines. The job also involves coding because each medical procedure and patient encounter has a number, or CPT code, associated with it which corresponds to another code for a diagnosis. This helps the insurance company account for, and track the money they reimburse to physicians and practices, to help prevent medical claims or errors in payment.