Medical Specialist

OverviewMedical Specialist - The Auto Club GroupJoin the team committed to driving your career forward.Job TypeFull timeExempt/Non ExemptSalaryWhat you will doWhat you will do:The Auto Club Group is seeking prospective Medical Specialist who will review medical documentation on billing software to determine appropriateness of medical care as it relates to automobile accidents.In this position, you will have the opportunity to: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.With our powerful brand and the mentoring, we offer, you will find your position as a Medical Specialist can lead to a rewarding career at our growing organization.Compensation & BenefitsHow you will benefit:A Medical Specialist will earn a competitive salary of $75,000 - $80,000 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 MatchMedicalDentalVisionPTOPaid HolidaysTuition ReimbursementQualificationsWe\'re looking for candidates who (Preferred/Required Qualifications):Required Qualifications (these are the minimum requirements to qualify)Education (minimum education and any licensing/certifications):Associate\'s degree in nursing with licensure in State of Michigan as a Registered NursePossession of a valid driver\'s licenseExperience:Quality assurance/utilization reviewMonitoring medical records to assess and evaluate utilization of services, quality of care, and identification of potential risk factorsConducting special studies/analyses and summarizing findings in report formResearch statistics and quality improvement methodologiesKnowledge and Skills:Knowledge of:Injury rehabilitation techniquesUtilization review and quality assurance standards and programs through reading and attendance at seminars and involvement in professional organizationsPersonal computers, including word processing, spreadsheet and database software packagesCPT and ICD-9 codingAbility to:Provide education and technical information to staff regarding utilization review and company standard medical protocols and changesWork effectively with customersCommunicate effectively with others in a work environment, other professionals and health care providers, and with the publicGather and analyze data and reports, identify discrepancies, problems or issues and recommend action plans based on findingsAnalyze complex reports and information related to and resulting from quality reviewsUtilize computer systemsWork with a team on individual claims to ensure appropriateness of treatmentStrong written and oral communication skillsMust reside in the state of MichiganPreferred QualificationsEducation:Bachelor\'s degree in nursingWork EnvironmentThis position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership.
This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.Who We AreBecome a part of something bigger.The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands.
ACG belongs to the national AAA federation and is the second largest AAA club in North America.By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life\'s journey through insurance, travel, financial services, and roadside assistance.And when you join our team, one of the first things you\'ll notice is that same, whole-hearted, enthusiastic advocacy for each other.We have positions available for every walk of life
AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.To learn more about AAA The Auto Club Group visit NoteACG\'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 principal 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 fulfill these requirements.The Auto Club Group, and all 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.Regular and reliable attendance is essential for the function of this job.AAA The Auto Club Group is committed to providing a safe workplace.
Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.
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