Teams at MedReview

Coordinates and resolves nonclinical healthcare appeals, grievances, complaints, and provider inquiries. Responsibilities include researching cases, preparing external review and state hearing files, tracking deadlines, determining outcomes, drafting responses, consulting clinical and operational teams, and ensuring compliance with timeliness and accuracy standards. The role requires healthcare industry experience, knowledge of claims payment methodology, strong analytical and communication skills, and proficiency with Excel and WebStrat.

The Physician Reviewer will evaluate complex hospital cases for DRG validation, ensure accurate documentation, and contribute to quality assurance initiatives.

Perform inpatient claim reviews to validate ICD-10-CM/PCS coding and correct DRG assignment per Official Coding and Reporting Guidelines, collaborate with physician reviewers, meet productivity and accuracy targets, and maintain required coding credentials and continuing education.