Medical Review Specialist

Location: Remote (Work From Home)
Pay: $25.00/hour
Schedule: Monday–Friday, 8:30 AM–5:00 PM (40 hours/week)
Type: Temporary (approx. 3–6 months)

Overview

Seeking a Medical Review Specialist to create and write reports based on medical records and appropriate guideline criteria. You’ll analyze provider billing for proper coding/billing guidelines across multiple provider types, ensuring high-quality, compliant reviews.

What You’ll Do

• Enter and verify claim/examinee data in the system database
• Review claims for completeness; resolve missing or inconsistent information
• Identify billing type (physician, hospital, surgery center, etc.) and process medical bills through the review system
• Apply coding and billing guidelines (including client-specific requirements) and make manual adjustments as needed
• Perform quality checks before finalizing each case
• Maintain documentation and ensure audit readiness
• Communicate issues/updates to management and coordinate with IT support as needed
• Respond to incoming requests (phone/email/fax) regarding report status and information
• Work in full compliance with HIPAA and applicable regulations

Requirements

• Current certification (one required): OASIS, RAC-CT, or CCS
• Strong understanding of medical billing and coding concepts, including CPT, ICD-10, bundling/unbundling, duplicate billing, utilization review, fee schedules, and CMS reimbursement guidelines
• Proficiency with Microsoft Office (Word/Outlook/ Excel ) and internet-based systems
• Detail-oriented; able to work independently, prioritize, and maintain confidentiality
• Typing minimum: 35 WPM

Benefits available to full-time employees after 90 days. 401(k) with company match available after 1 year (per eligibility dates).