TriWest Healthcare Alliance

  • Medical Review Clerk

    Recruiting Location Phoenix, AZ
    ID 2019-2832
  • Overview

    Location: Phoenix, AZ


    Reviews medical documentation to determine correct coding on submitted medical and behavioral health claims utilizing appropriate clinical staff resources as needed to assist in review.  Update authorizations as necessary with appropriate codes.


    • Conducts medical documentation review to determine appropriateness of coding of service
    • Validates medical determinations through research of resources including regulatory manuals, computer files and documentation.
    • Assists in preparation of cases for program payment or medical director review as indicated. 
    • Validates all appropriate data is supplied with program invoice.
    • Reviews Authorization data for process improvements
    • Ensures contract compliance for timelines regarding resolution of medical documentation review and updates
    • Communicates effectively with management and peers.
    • Consistently meets quotas for position
    • Identifies and reports any potential quality or fraud issues to management, Quality Management or Program Integrity as needed.
    • Provides support regarding clinical and coding questions.
    • Performs other duties as assigned.
    • Regular and reliable attendance is required.



    • High school diploma or G.E.D.
    • 1+ years claims review experience
    • Medical terminology knowledge
    • 1+ years working with medical documentation


    • Claim coding experience
    • Knowledge of Behavioral health claims review
    • Certified Processional Coder (CPC)


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