Develop data mining audits to identify improper payments and promote payment accuracy across Medicaid, Medicare, and Commercial lines of business. Collaborate with analytics and operations teams to define data selection parameters and provide training for audit staff.
MedReview
10 Remote Job Openings at MedReview
The specialist will serve as the primary subject matter expert to translate SNF regulatory and clinical requirements into scalable audit methodologies and product workflows. They will define the product roadmap, validate claim selection logic, and ensure the program is clinically sound and compliant with state and federal regulations.
The Data Scientist will collaborate with cross-functional teams to design, build, and operationalize predictive models to solve business challenges. They are responsible for gathering and cleaning data, performing exploratory analysis, and communicating insights to stakeholders using visualization tools.
The Senior Director of Coding Operations manages a team of 75+ employees to ensure high-quality coding deliverables and operational efficiency. They are responsible for strategic growth, process optimization, and maintaining compliance with regulatory standards.
The Physician Reviewer will perform DRG clinical validation reviews to ensure accurate diagnoses and compliance with evidence-based guidelines. They will also produce clinical summaries and collaborate with internal teams to support documentation accuracy and healthcare quality.
The Appeals Specialist II is responsible for researching, investigating, and analyzing appeals and grievances to ensure timely resolution. They prepare case files for external reviews and manage appeals from non-participating providers.
The Clinical Review Medical Director is responsible for reviewing hospital medical records for DRG Clinical Validation Review and ensuring diagnoses are appropriately billed. They will also produce clinical summaries and assist with various review activities related to patient care and management.
Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record. Maintain and manage case reviews with a high emphasis on quality in a fast-paced environment.
The Appeals Coordinator II assists Appeals leadership with daily administrative work, performing research, investigation, and analysis of appeals and grievances. They ensure timely resolution of complaints while maintaining compliance with guidelines and standards.
The DRG Reviewer will conduct reviews of inpatient claims for coding accuracy and perform screening referrals for clinical support of coded diagnoses. They will analyze and review claims to validate reported codes and ensure proper DRG assignment.
