
Medical Reviewer
5 days ago
This role is a medical reviewer responsible for verifying the accuracy of patient medical records.
The incumbent will investigate and detect fraudulent activity perpetrated by providers, members, and facilities.
Key Responsibilities:- Verify medical records for completeness and accuracy
- Conduct investigations to identify fraudulent activity
- Gather information through interviews and field investigations
- Testify in court as needed
- 7-9 years of relevant work experience
- Medical degree (MBBS, BHMS, BAMS, BUMS) or equivalent from a reputable university
- Certified Medical Coder with valid certification from AAPC or AHIMA
- In-depth knowledge of anatomy, physiology, and disease processes
- Ability to work independently and as part of a team
- Knowledge of payor side business and denial handling experience
- Relevant experience in healthcare fraud investigations
- Exposure to professional billing, HIM, internal audit, and provider contracting
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Medical Reviewer
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