Medical Review Specialist-Remote {175123}

Job Description

Job Description

Medical Review Specialist (Remote)

A-Line Staffing is hiring a  Medical Review Specialist for a  fully remote contract role. In this position, you’ll create written reports based on medical records and apply appropriate billing/coding guidelines to ensure accurate, compliant claim reviews.

Location: Remote (U.S.)
Schedule: Monday–Friday, 8:30 AM – 5:00 PM (Eastern)
Hours: 40 hours/week
Pay:  $25/hour (W2)
Duration: Contract (estimated 3–6 months )

What You’ll Do

• Create and write reports based on medical records and established guideline criteria
• Enter and process medical bills in the review system (supports automated adjudication)
• Identify billing type (physician, hospital, surgery center, etc.) and ensure correct handling
• Apply coding and billing guidelines (industry standards and client-specific requirements)
• Resolve missing or inconsistent information by contacting the appropriate parties as needed
• Perform quality checks on each case before completion
• Maintain accurate documentation and ensure audit-ready file organization
• Support invoicing activities aligned with applicable fee schedules
• Respond to incoming calls/emails/faxes regarding status and report questions
• Escalate issues such as appeals, profile changes, system errors, or data concerns

Required Qualifications

• Current certification (one required):   OASIS, RAC-CT, or CCS
• Strong understanding of medical billing and claim review workflows
• Working knowledge of:
• • CPT guidelines, ICD-10, bundling/unbundling, duplicate billing
  • Fee schedules, UCR/UC&R review, CMS reimbursement guidelines
  • Drug/supply charges, utilization review concepts
• Proficiency with Microsoft Office (Word/Excel/Outlook) and internet-based systems
• Ability to type 35 WPM+
• Excellent attention to detail, ability to work independently, and maintain confidentiality
• Must follow  HIPAA and applicable regulatory requirements

Benefits

Benefits may be available to eligible employees per A-Line’s standard offerings (medical/vision/dental).  401(k)eligibility may apply based on tenure and plan rules.

Interested? Apply / Reach Out

Austin Faris
A-Line Staffing Solutions
Phone: View phone number on ziprecruiter.com