MEDICAL REVIEW SPECIALIST

MEDICAL REVIEW SPECIALIST Location: Rockford, IL Work Environment: Remote Pay rate: 25.00 per hour Schedule: Monday–Friday, 8:00 AM–4:30 PM CST

POSITION SUMMARY The Medical Review Specialist is responsible for reviewing medical records, provider billing, claims, and related documentation for accuracy, completeness, appropriate coding, and compliance with established medical, billing, and client guidelines. This position requires strong attention to detail, knowledge of medical coding and reimbursement practices, excellent documentation skills, and the ability to identify and resolve discrepancies. The Medical Review Specialist will work independently in a remote environment while maintaining strict compliance with HIPAA, legal requirements, safety standards, and client-specific guidelines.

KEY RESPONSIBILITIES

• Create accurate and detailed reports based on medical records, documentation, and applicable medical guidelines.
• Analyze provider billing for appropriate coding and adherence to billing guidelines across various provider types.
• Review claims for completeness, accuracy, consistency, and compliance with industry standards and client requirements.
• Review medical records and supporting documentation to identify missing, inconsistent, or inaccurate information.
• Contact clients to resolve questions, discrepancies, inconsistencies, or missing information.
• Perform quality assurance reviews before reports and assignments are finalized.
• Ensure medical records, reports, and supporting documentation are accurately maintained and stored for audit purposes.
• Respond to client inquiries regarding report status, documentation, and review information.Maintain accurate records while protecting confidential patient and client information.
• Follow HIPAA requirements, company policies, safety standards, and applicable federal and state regulations.
• Promote the efficient and appropriate use of company resources.
• Notify management of issues, process updates, client profile changes, or other concerns requiring attention.
• Maintain productivity and accuracy while working independently in a remote environment.

REQUIRED QUALIFICATIONS

• Education & Certifications CCP or CPC-A certification required.
• Knowledge of medical billing and medical coding practices.
• Knowledge of CPT coding guidelines and ICD-10 classification.
• Knowledge of CMS reimbursement guidelines.
• Understanding of fee schedules, medical review processes, and provider billing practices.
• Knowledge of HIPAA regulations and healthcare privacy requirements.