Job Description
We are seeking a highly skilled Medical Record Utilization Reviewer to provide support on an as‑needed basis. This flexible, remote position is activated during periods of increased volume, staff shortages, special projects, or payer‑related deadlines. The ideal candidate is experienced in analyzing medical records, identifying disallowed charges, drafting persuasive dispute letters, and preparing reconsideration requests. A strong understanding of NUBC standards, InterQual criteria, CMS/Medicare guidelines, and payer‑specific requirements is essential for success in this role.
Key Responsibilities
Review medical records and itemized billing statements to identify discrepancies, disallowed charges, and non‑compliant billing patterns.
Cross‑reference clinical documentation with itemized charges to ensure accuracy and compliance with medical necessity standards.
Prepare detailed, well‑supported reports outlining findings and recommendations for charge adjustments.
Draft and submit professional dispute letters, appeals, reconsideration requests, and justifications to insurers and payers.
Research and apply NUBC, CMS, InterQual, and payer‑specific guidelines to all reviews and appeals.
Analyze denied claims, prepare detailed appeals, and provide written rationale for reconsideration.
Collaborate with internal departments to ensure alignment on billing compliance and appeal strategies.
Maintain high levels of accuracy, confidentiality, and timely communication while working independently during PRN assignments.
Qualifications
Proven experience in medical record utilization review, billing compliance, or claims adjudication.
Strong knowledge of NUBC standards, InterQual criteria, and CMS/Medicare guidelines.
Excellent written communication skills with experience drafting dispute letters, appeals, and reports.
Familiarity with UB‑04 forms, itemized billing, and insurance claims.
Detail‑oriented with strong analytical and organizational skills.
Experience with insurance appeals, denials management, and claims processing is a plus.
Ability to work independently in a remote environment and respond quickly during PRN activations.
Preferred Skills
Prior experience in healthcare payer systems or private insurance organizations.
Proficiency in interpreting clinical documentation to determine medical necessity and compliance.
Strong time‑management skills and ability to handle fluctuating workloads.
Work Schedule
PRN / As‑Needed: Hours vary based on organizational demand.
May require occasional short‑notice availability during peak periods or urgent deadlines.
No guaranteed minimum hours.
Work Benefits
100% Remote Work – Work from home with no commute.
Flexible Schedule – High autonomy and the ability to manage your own working hours.
Work‑Life Balance – Assignments based on availability and operational needs.
Professional Growth – Opportunities to strengthen utilization review and compliance skills.
Collaborative Culture – Supportive team environment for consultation and development.
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