Medical Records Reviewer

Job Description

Job Description

A-Line Staffing is now hiring a Full-Time, On-Site, Medical Records Content Reviewer in Harrisburg, PA!

Position Summary

We are seeking a detail-oriented Medical Records Content Reviewer ! The ideal candidate will possess strong healthcare documentation review experience and a thorough understanding of medical coding, billing compliance, and healthcare regulations.

This role is responsible for reviewing and evaluating outpatient healthcare services provided under the Medical Assistance Program to ensure quality, medical necessity, appropriate billing practices, and compliance with state and federal regulations.

Medical Records Content Reviewer Compensation

• The pay for this position is $20.00/hr
• Benefits are available to full-time employees after 90 days of employment
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates

Medical Records Content Reviewer Highlights

• This position is a contract assignment with potential to hire on permanently based upon attendance, performance, and business needs
• The required availability for this position Monday – Friday | 8:00am-4:00pm

Medical Records Content Reviewer Responsibilities

Medical Records & Claims Review

• Identify discrepancies through analysis of paid claims, computer-generated reports, and utilization patterns.
• Review high-cost, high-volume providers and identify potential cases for further investigation.
• Conduct retrospective reviews to monitor compliance with state and federal regulations.
• Evaluate services for medical necessity, quality of care, billing accuracy, and adequacy of documentation.
• Verify that ordered services were rendered and that rendered services were appropriately authorized.

Compliance & Coding Analysis

• Analyze claims for potential upcoding, duplicate billing, unbundling, and other billing irregularities.
• Utilize ICD-10-CM diagnosis and procedure manuals, CPT, HCPCS, coding clinics, and related resources to validate claims accuracy.
• Ensure provider billing practices comply with Medical Assistance Program requirements and applicable regulations.

Case Management & Reporting

• Prepare case findings, summaries, and correspondence for providers.
• Research and apply Medical Assistance regulations, bulletins, and federal regulations during case reviews.
• Maintain accurate case documentation within Case Tracking Systems.
• Function as case coordinator by planning and conducting review activities efficiently and within established timelines.
• Prepare memoranda, reports, letters, and other written materials documenting findings and recommendations.

Provider & Stakeholder Collaboration

• Conduct in-house reviews of medical and fiscal records to verify services rendered.
• Coordinate and participate in teleconferences and meetings with providers, physician consultants, legal counsel, and other stakeholders.
• Participate in evidentiary meetings and assist in developing case strategies and sanction recommendations.
• Respond to and track complaints received through multiple channels, including hotlines, emails, websites, letters, and phone calls.

Medical Records Content Reviewer Requirements

·         Associate's Degree in Health Services Management or a related field; OR

·         Minimum of two (2) years of experience in healthcare management, preferably in an outpatient setting

·         Knowledge of healthcare documentation, medical records review, and claims analysis

·         Familiarity with ICD-10-CM, CPT, and HCPCS coding systems

·         Proficiency in Microsoft Office Suite, including Excel

·         Strong analytical, written, and verbal communication skills

·         Ability to maintain confidentiality and handle sensitive information

If you think this  Medical Records Content Reviewer position is a good fit for you, please reach out to me—feel free to call, e-mail, or apply to this posting