Medical Record Reviewer III (Profee)

Eightelevengroup; Dayton (OH); Remote; USD 48,000 - 58,000; Full time

Benefits offered by this job

Remote work flexibility

Contract-to-full-time opportunity

Competitive hourly compensation

Professional growth in healthcare

Job summary

Medasource is seeking a Program Integrity Medical Record Reviewer III for a remote, contract-based position with potential for full-time employment. You will perform detailed line-level medical coding reviews of healthcare claims to ensure billed services are supported by medical records and comply with CMS, Medicare, Medicaid, and internal coding guidelines.

The role involves identifying coding discrepancies, overpayments, and payment integrity concerns, collaborating with audit teams,

Qualifications

• Extensive experience in medical coding and billing review.
• Thorough knowledge of CMS, Medicare and State Medicaid coding guidelines.
• Ability to review a broad range of claim types, including professional, E/M, DRG and lab claims.
• Strong attention to detail for identifying coding discrepancies and payment integrity concerns.
• Proven ability to maintain productivity and quality in a high-volume environment.

Responsibilities

• Perform detailed, line-level medical coding reviews of healthcare claims.
• Review medical records and compare documentation against submitted claims for coverage and coding requirements.
• Apply CMS guidelines, State Medicaid requirements, Medicare requirements and internal policies to claim reviews.
• Review a wide range of claim types (professional, E/M, DRG, sepsis, readmissions, labs, specialty).
• Identify coding discrepancies, unsupported services and potential overpayments.
• Maintain productivity with current averages of 4–5 claims per hour and improve with workflow.
• Participate in quality assurance processes and respond to feedback.
• Collaborate with audit and investigation teams to communicate findings.
• Help identify trends warranting provider review or education.
• Ensure compliance with regulatory and organizational requirements.
• Respond promptly to feedback and incorporate QA recommendations.

Job description

Title: Program Integrity Medical Record Reviewer III

Location: Remote

Compensation: $35 - $42 per hour

Contract Length: 6 months with potential for full-time employment

Hours: 8am–5pm initially, with flexibility after the first month

Start Date: ASAP

ABOUT THE ROLE

Our client is seeking a Program Integrity Medical Record Reviewer III to join their team in a remote, contract-based position with the potential for full-time employment. In this role, you will conduct detailed medical coding reviews of healthcare claims, supporting both pre-pay and post-pay claim reviews across multiple lines of business and specialties. You will play a critical role in ensuring that billed services are accurately supported by medical records and comply with CMS, Medicare, Medicaid, and internal coding guidelines. The position involves identifying coding discrepancies, potential overpayments, and payment integrity concerns, as well as collaborating with Program Integrity and SIU investigators to communicate audit findings and support provider-level decisions. You will thrive in a fast-paced, production- and quality-driven environment, maintaining high productivity and quality standards while ensuring compliance with all regulatory and organizational requirements.

WHAT YOU'LL DO

• Perform detailed, line-level medical coding reviews of healthcare claims.
• Review medical records and compare documentation against submitted claims to determine if billed services are supported by the medical record and applicable coding requirements.
• Apply CMS coding and billing guidelines, State Medicaid requirements, Medicare requirements, official coding guidelines, and internal coding and payment policies to claim reviews.
• Review a broad range of claim types, including professional claims, E/M services, DRG, sepsis, readmissions, laboratory services, and other specialty-specific claims.
• Identify coding discrepancies, unsupported services, potential overpayments, and other payment integrity concerns.
• Maintain established productivity and quality standards, with current production averages of 4–5 claims per hour and expectations to increase as workflow is streamlined.
• Participate in ongoing quality assurance processes, including review of completed claims, responding promptly to feedback, and making necessary corrections.
• Collaborate with Program Integrity and SIU investigators to communicate audit findings and support provider-level decisions.
• Help identify trends or patterns that may warrant additional provider review, education, or investigation.
• Maintain compliance with all applicable regulatory, coding, and organizational requirements.
• Respond quickly to feedback and incorporate quality assurance recommendations, with target quality accuracy of approximately 90%.

WHAT YOU BRING

• Extensive experience in medical coding and billing review, including pre-pay and post-pay claim review processes.
• Thorough knowledge of CMS, Medicare, and State Medicaid coding guidelines, as well as official coding guidelines and payer-specific policies.
• Ability to review and analyze a broad range of claim types (e.g., professional, E/M, DRG, sepsis, readmissions, laboratory, and specialty claims).
• Strong attention to detail in identifying coding discrepancies, unsupported services, and payment integrity concerns.
• Demonstrated ability to maintain productivity and quality standards in a high-volume, production- and quality-driven environment.
• Effective communication and collaboration skills, with experience working alongside audit and investigation teams.
• Commitment to compliance with regulatory and organizational requirements, and proficiency in responding to feedback and incorporating quality assurance recommendations.
• Ability to quickly adapt to new workflows and case management platforms, with a focus on continuous improvement and accuracy.

WHAT'S IN IT FOR YOU

• Remote work flexibility
• Opportunity for contract-to-full-time employment
• Competitive hourly compensation
• Engagement in a mission-driven, quality-focused team
• Professional growth in a dynamic healthcare environment

Benefits & Perks

• Medasource offers competitive medical, dental, vision, Health Savings Account, Dependent Care FSA, and supplemental coverage with plans that can fit each employee’s needs.
• We offer a 401k plan that includes a company match and is fully vested after you become eligible, paid time off, sick time, and paid company holidays.
• We also offer an Employee Assistance Program (EAP) that provides services like virtual counseling, financial services, legal services, life coaching, etc.

Equal Opportunity Statement

Medasource is an equal opportunity employer that does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, lactation and related medical conditions), gender identity or gender expression, sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances.

Pay Disclaimer

The pay range for this job level is a general guideline only and not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law.

Medical Record Reviewer III (Profee) Dayton, Ohio