Medical Reviewer

 We are looking for a meticulous and experienced Medical Reviewer to evaluate clinical documents, medical records, and claims to ensure accuracy, completeness, and compliance with regulatory standards. The ideal candidate will have a strong medical background and the ability to interpret clinical data to support quality assurance, regulatory compliance, and accurate reimbursement. 

• Review medical records, clinical documentation, and claims for accuracy and compliance with policies and guidelines.
• Verify medical necessity and ensure proper documentation supports diagnoses and procedures.
• Identify inconsistencies or errors in clinical data and communicate findings to the appropriate teams.
• Collaborate with physicians, nurses, and other healthcare professionals to resolve documentation or coding discrepancies.
• Prepare detailed review summaries and reports of findings.
• Stay up to date on healthcare regulations, payer policies, and clinical review standards.
• Assist in audits and quality assurance initiatives as needed.
• Maintain strict confidentiality and adhere to HIPAA and company compliance policies.

• Licensed Registered Nurse (RN), Licensed Practical Nurse (LPN), or equivalent healthcare background preferred.
• Minimum of 2 years’ experience in clinical review, utilization management, or medical auditing.
• Knowledge of ICD-10, CPT, and medical documentation standards.
• Strong analytical, decision-making, and problem-solving skills.
• Excellent written and verbal communication abilities.
• Proficient in using EHR systems, Microsoft Office, and data review tools.
• High attention to detail and accuracy.
• Ability to work independently in a remote setting.

• Computer or Laptop – Minimum 8GB RAM with reliable processor (i5 or higher).
• Stable Internet Connection – Minimum 20 Mbps download speed.
• Noise-Cancelling Headset – For clear communication with teams and clients.
• External Webcam – For virtual meetings and training sessions.
• Backup Power Supply – Such as UPS or generator to prevent interruptions.