What are the responsibilities and job description for the Medical Review Specialist position at Christian Healthcare Ministries?
The Medical Review Team at Christian Healthcare Ministries (CHM) is entrusted with representing the organization’s vision and mission, particularly regarding the determination of pre-existing conditions and alternative treatment protocols. Equipped with specialized training under the guidance of the Medical Director, this team continuously updates their insights into traditional medical standards and medical record reviews.
The Medical Review Specialist is responsible for reviewing, analyzing, and interpreting medical documentation to ensure accuracy, compliance, and alignment with CHM’s eligibility guidelines. This position requires a detail-oriented professional who can manage complex cases with compassion and uphold the values of CHM while working directly with members and staff.
WHAT WE OFFER
- Compensation based on experience.
- Faith and purpose-based career opportunity!
- Fully paid health benefits
- Retirement and Life Insurance
- 12 paid holidays PLUS birthday
- Lunch is provided DAILY.
- Professional Development
- Paid Training
ESSENTIAL JOB FUNCTIONS
- Review medical records thoroughly to assess eligibility and 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, demonstrating compassion and professionalism while de-escalating tense situations.
- 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 communication skills (written and verbal) 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 environment 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 working 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 a high level of confidentiality, professionalism, and compliance with CHM policies.
- Ensure positive interactions with members and staff through clear, compassionate communication.
- Consistently support CHM’s mission and organizational goals through collaborative problem-solving and member-focused service.
PERFORMANCE EXPECTATIONS
- Standard hours: Monday–Friday, 9:00 AM – 5:00 PM
- Hybrid work potential available after successful completion of training and demonstration of performance standards.
- Work is primarily sedentary, requiring extended periods of 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 other office equipment.
- Occasional lifting of up to 20 pounds (e.g., files or records).
- Work performed in a 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.