Physician Reviewer

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MedReview Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

💸 Finance

Healthcare Insurance • Finance

MedReview Inc. is a leading provider of advanced payment integrity solutions, specializing in healthcare claims. They work with a wide range of clients, including health plans, government agencies, and payors, to reduce unnecessary waste and save billions of dollars. Their team of highly trained physicians, registered nurses, and certified coders conduct thorough clinical and coding reviews to identify inaccuracies in healthcare claims. MedReview employs proprietary algorithms to analyze complex data and detect suspicious payment trends, offering a unique blend of clinical expertise and advanced technology to maximize efficiencies and improve healthcare cost management.

📋 Description

• Perform DRG Clinical Validation reviews to ensure diagnoses are accurate, supported, and compliant • Evaluate medical records, diagnostic findings, and treatment plans using evidence-based guidelines • Produce clear, concise clinical summaries and determinations within established turnaround times • Identify opportunities for improved documentation, coding accuracy, and cost containment • Conduct readmission and level of care reviews, including outlier and appeal cases • Collaborate with internal teams and, when needed, engage with providers to support clinical findings • Contribute to quality assurance initiatives and ongoing program development.

🎯 Requirements

• MD/DO required with active, unrestricted U.S License • Board Certification required (ABMS or AOA) • 5+ years of clinical practice experience • Strong utilization review experience (UM, DRG Validation, or clinical documentation review) • Experience with DRG Validation, CDI, or claims review strongly preferred • Proven ability to interpret complex clinical data and apply guidelines objectively • Strong written communication skills with the ability to clearly justify clinical decisions.