• Medical Records Review & Quality Assurance • Perform final quality reviews of completed medical record requests before delivery to clients. • Verify the accuracy, completeness, organization, and consistency of medical records. • Identify missing documents, inconsistencies, clinical errors, and documentation gaps. • Ensure all deliverables meet company quality standards. • AI-Assisted Medical Review • Review and validate AI-generated medical summaries, chronologies, and case insights. • Apply clinical knowledge to refine, correct, and enhance AI-generated outputs. • Ensure summaries accurately reflect the underlying medical documentation. • Issue Identification & Escalation • Detect deficiencies, missing information, or quality concerns within completed requests. • Escalate issues to the appropriate internal teams for timely resolution. • Communicate findings clearly and professionally. • Process Improvement • Provide feedback on AI performance, document processing workflows, and internal review tools. • Collaborate with engineering and product teams to improve AI models and operational processes. • Share observations that help enhance review accuracy and efficiency.

Title: Physician Kelsey Seybold Allergy at Springwoods Village Location: Spring United States Job Description: Requisition number: 2343572 Job category: Healthcare Delivery Overtime status: Exempt Travel: No Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. Position Highlights: The Department of Allergy and Immunology for Adults provides consultative services for the diagnosis, evaluation and management of diseases of the respiratory tract, immune system and allergies. The Allergy/Immunology department provides consultation in the diagnosis and management of allergies and immune-deficiency diseases. A multidisciplinary team of physicians and nurses offers patient management, patient/family education and support services. Some of the chronic ailments and illnesses treated are: asthma, food or drug allergies, and insect hypersensitivity. Essential Duties And Responsibilities include the following. Other assignments, projects and duties may be required: - Interviewing patients and families - Performing complete physical examination - Ordering appropriate diagnostic studies, diets, and nursing monitoring and intervention - Recognition of clinical problems and formulation of a logical diagnosis - Evaluation and management of adult/pediatric allergy and immunological conditions which may or may not pose the threat of death, organ or system failure, irreversible organ or system failure, irreversible damage or loss of permanent impairment of a body function - Evaluation and management of allergy and immunological diseases - Interpretation of diagnostic laboratory studies - Allergy testing: percutaneous, antibiotics, biologicals, stinging insects' antigens, intradermals - Immunizations - Ingestion challenge testing - Inhalation therapy - Application of local and topical anesthesia What makes an Optum Career different? - Be part of a best-in-class employee experience that enables you to practice at the top of your license - We believe that better care for clinicians equates to better care for patients - We are influencing change collectively on a national scale while still maintaining the culture and community of our local care organizations - Practice medicine autonomously, with the support, not restrictions, of a sustainable and thriving national health care organization You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: - Graduate of an approved training program in the United States - Board Certified and/or Board Eligible - Licensed in the state of Texas Compensation for this specialty generally ranges from $254,000 - $485,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Role Description We are rapidly expanding our Medical Records Team and are looking for a detail-oriented Records Reviewer to join us immediately. This is a long-term opportunity for professionals with a healthcare background who are passionate about quality, accuracy, and innovation. As a Records Reviewer, you will serve as the final quality checkpoint before medical records are delivered to clients. You'll work closely with our proprietary AI technology to review, validate, and improve medical summaries, chronologies, and case insights while collaborating with internal teams to continuously enhance our review processes. If you have experience reviewing medical records, strong clinical knowledge, and exceptional attention to detail, we'd love to hear from you. Key Responsibilities - Medical Records Review & Quality Assurance - Perform final quality reviews of completed medical record requests before delivery to clients. - Verify the accuracy, completeness, organization, and consistency of medical records. - Identify missing documents, inconsistencies, clinical errors, and documentation gaps. - Ensure all deliverables meet company quality standards. - AI-Assisted Medical Review - Review and validate AI-generated medical summaries, chronologies, and case insights. - Apply clinical knowledge to refine, correct, and enhance AI-generated outputs. - Ensure summaries accurately reflect the underlying medical documentation. - Issue Identification & Escalation - Detect deficiencies, missing information, or quality concerns within completed requests. - Escalate issues to the appropriate internal teams for timely resolution. - Communicate findings clearly and professionally. - Process Improvement - Provide feedback on AI performance, document processing workflows, and internal review tools. - Collaborate with engineering and product teams to improve AI models and operational processes. - Share observations that help enhance review accuracy and efficiency. Qualifications - Healthcare or Medical Records Experience (Required) - Previous experience reviewing medical records OR a professional healthcare background such as: - Registered Nurse (RN) - Licensed Practical/Vocational Nurse (LPN/LVN) - Medical Assistant - Healthcare Administrator - Medical Records Specialist - Health Information Management (HIM) - Or a similar healthcare-related role - Strong understanding of: - Medical terminology - Clinical documentation - Medical record structures - Healthcare workflows - Technical Skills: - Comfortable working with modern software platforms and AI-powered tools. - Quick learner with the ability to adapt to new technologies. - Strong computer literacy and attention to digital workflows. - Communication Skills: - Excellent written English communication skills. - Ability to write clear, concise, and professional documentation. - Comfortable communicating issues and recommendations to internal teams. - Core Competencies: - Exceptional attention to detail with a commitment to producing high-quality work. - Strong analytical and critical thinking skills to interpret medical information accurately. - Clinical judgment to evaluate the relevance and accuracy of medical events and documentation. - Dependability and accountability with the ability to work independently in a remote environment. - Proactive communication by identifying issues early and collaborating with the team. - Long-term commitment and a desire to grow with our company as we continue to scale our AI and medical review capabilities. How to Apply If you have a healthcare background, experience reviewing medical records, and a passion for quality and accuracy, we'd love to hear from you. Please Apply here: https://operationsarmy.com/application Qualified applicants will be contacted for the next stage of the hiring process.

Role Description Perform automated and complex medical record and claim reviews to make coverage determinations based on applicable Medicare coverage policies and payment rules, coding guidelines, National and Local Coverage Determinations, utilization/practice guidelines, and clinical review judgment. Provides professional assessment, planning, coordination, implementation, and reporting of complex data to support the Recovery Auditor Validation Contract (RVC). Essential Functions - Perform accuracy review of automated and complex Medicare medical record and claims review in accordance with all State and Federal mandated regulations/guidelines. - Perform accuracy reviews as a Special Study requested by CMS. - Document findings for each claim in a clear and concise manner. - Compile a report explaining the claim reviews, including identified patterns, inappropriate determinations, as well as recommendations. - Reasonably determines appropriateness to consult a Subject Matter Expert (SME) for clarification. - Perform medical record reviews in response to RAC disputes/disagrees with the RVC review decisions. - Perform accuracy review of the New Issue Proposal for appropriate regulations, references, policies, and edit parameters. Compile a report of analysis and recommendations to submit to CMS. - Perform New Issue Quality Assurance Review for accuracy of all criteria and references. - Consistently meet or exceed productivity and accuracy standards of 95% minimum IRR established by the customer and/or the Company. - Report problems to the Medical Review Manager (MRM) and Project Manager (PM) regarding unique record or process issues. - Maintain security and confidentiality of medical records and Protected Health Information (PHI) and Personally Identifiable Information (PII). - Consistently meet attendance standards established by the Company and follows the telecommuting policy. - Interact appropriately with peers, co-workers, other Contractors, and the customer, when necessary. Contribute to building a positive team spirit. - On occasions may be asked by the MRM or PM to assist with development of training and/or resource materials. - May be asked to assist with precepting of new Medical Review Nurses (MRNs). - Perform other duties and projects as assigned. Qualifications - Registered Nurse, with a current unobstructed license to practice nursing in the United States. Graduate of a Board approved Registered Nursing program. - A Bachelor’s Degree in Nursing (BSN) or other related field is preferred. - Certification in coding highly preferred. - A minimum of three (3) years clinical experience in an acute care hospital, skilled nursing facility, and/or an office/clinic-based medical practice. - A minimum of three (3) or more years’ experience in medical/utilization medical record review particularly with Medicare and/or Medicaid. - Proficiency in research, interpretation, and application of Medicare, Medicaid, and local healthcare regulations and policies. - Must be proficient in Microsoft Office Suite such as Outlook, Excel and Word. Skills & Abilities - Ability to work independently and maintain an elevated level of concentration. - Capable of consistency, speed, and accuracy of task. - Ability to read, analyze, and interpret physician documentation. - One year or more of utilizing InterQual and/or Milliman guidelines against inpatient services experience is preferred. - Ability to communicate clearly and professionally with all levels of the organization, both written and verbal. - Ability to work well in a remote team environment, to collaborate with others, and interface with team members internal and external to the organization. - Establishes and maintains effective professional relationships with internal and external stakeholders. - Must be able to adapt to organizational change. - Must be proficient in Microsoft Office Suite such as Outlook, Excel, and Word. - Flexibility and ability to plan, prioritize, and execute multiple tasks in a fast-paced environment. - Self-motivated, well-organized, and detail oriented. - Ability to maintain a high level of confidentiality and integrity. Benefits - The annual salary range for this position is $80,000 to $95,000. - Actual compensation will depend on a range of factors, including but not limited to the individual’s skills, experience, qualifications, certifications, location, other business and organizational needs, and applicable employment laws. - RELI Group provides a variety of additional benefits to its employees.