Medical Reviewer
New
M
Merge API Integration SandboxHealth Insurance
Work from home, any time zone., any time zoneContractEntry
Salary20 - 50 USD per hour
Apply NowOpens the employer's application page
Job Details
- Languages
- Written English
- Experience
- 0–3 years
- Required Skills
- Analytical SkillsMS OfficeGoogle Workspace
Requirements
- MBBS, MD, BDS, BAMS, BHMS, PharmD, or equivalent degree
- Active registration with a recognized medical/dental council
- 0–3 years of experience
- Basic computer skills
- Familiarity with MS Office or Google Workspace
- Attention to detail
- Analytical thinking
- Written English proficiency
Responsibilities
- Review medical records, treatment plans, and billing documents for medical necessity and coding accuracy.
- Validate if clinical documentation supports prescribed procedures or medications.
- Prepare concise medical justifications for approval, denial, or modification of claims.
- Identify potential fraud, abuse, or errors in medical claims.
- Respond to query letters from insurers or legal teams within defined turnaround times.
- Maintain strict confidentiality of patient and provider data.
- Use internal web-based review platforms.
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