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Medical Documentation Reviewer Jobs (NOW HIRING)

Lead assigned supplemental medical review of key cases as needed, ensuring appropriate clinical interpretation, seriousness/expectedness considerations, and consistent medical documentation in the ...

Lead assigned supplemental medical review of key cases as needed, ensuring appropriate clinical interpretation, seriousness/expectedness considerations, and consistent medical documentation in the ...

Obtains and reviews medical documentation for required funding approval. * Responds to customers (internal and external) inquiries in a timely & professional manner. * Keeps the team abreast of order ...

Documentation Review Nurse

Flemington, NJ ยท On-site

$93K - $116K/yr

Documentation Review Nurse Position Summary The Documentation Review Nurse will apply expertise and ... Benefit offerings vary based on status and may include but not be limited to medical, dental ...

Review and request appropriate medical documentation according to insurance coverage requirements from physicians and clinical staff to ensure patient qualifies for medical services. * Follow up with ...

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Medical Documentation Reviewer information

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How much do medical documentation reviewer jobs pay per hour?

As of Jul 23, 2026, the average hourly pay for medical documentation reviewer in the United States is $41.20, according to ZipRecruiter salary data. Most workers in this role earn between $23.08 and $65.87 per hour, depending on experience, location, and employer.

What are Medical Documentation Reviewers?

Medical Documentation Reviewers are professionals who examine and evaluate medical records to ensure accuracy, compliance, and completeness. They review documentation for billing, coding, and regulatory standards, often working in healthcare facilities, insurance companies, or third-party review organizations. Their work helps prevent errors, supports proper reimbursement, and ensures that medical records meet legal and clinical requirements. Medical Documentation Reviewers must have strong attention to detail and a good understanding of medical terminology, healthcare regulations, and coding systems.

What are the key skills and qualifications needed to thrive as a Medical Documentation Reviewer, and why are they important?

To thrive as a Medical Documentation Reviewer, you need a solid understanding of medical terminology, clinical procedures, and healthcare regulations, often supported by a background in nursing, health information management, or medical coding certification. Familiarity with electronic health record (EHR) systems, coding software (such as ICD-10 and CPT), and auditing tools is typically required. Attention to detail, critical thinking, and strong written communication are crucial soft skills that help ensure accuracy and clarity in documentation. These competencies are essential for maintaining compliance, reducing errors, and supporting effective healthcare delivery.

What are some typical challenges faced by Medical Documentation Reviewers, and how can they be managed?

Medical Documentation Reviewers often encounter challenges such as interpreting complex medical terminology, ensuring compliance with regulatory standards, and managing large volumes of documents under tight deadlines. Staying organized and maintaining a keen attention to detail are crucial for accuracy. Regular training on medical coding updates and effective communication with healthcare providers can also help address ambiguities and improve documentation quality.
More about Medical Documentation Reviewer jobs
What states have the most Medical Documentation Reviewer jobs? States with the most job openings for Medical Documentation Reviewer jobs include:
Infographic showing various Medical Documentation Reviewer job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 69% Full Time, 27% Part Time, and 3% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $85,686 per year, or $41.2 per hour.

IBHS Clinical Documentation Reviewer

Dunbar Wellness Group

Philadelphia, PA โ€ข On-site

$62K - $75K/yr

Full-time

PTO

Posted 6 days ago


Job description

Job Type: Full-Time (W2)

Location: Philadelphia, PA (In-person)

Schedule: Monday โ€“ Friday (8:30 AM- 5 PM)


Our Mission

Dunbar Wellness Group, Inc. was founded by a group of dedicated community-based partners. Our mission is to integrate a holistic treatment approach that includes understanding community ecology and social advocacy for children and families in Philadelphia.

In addition, we promote quality therapeutic services that are resiliency and recovery-focused, trauma-informed, and culturally sensitive to the unique needs of urban children and families.

Position Summary

Reporting to the IBHS Clinical Director, the IBHS Clinical Documentation Reviewer is responsible for reviewing and monitoring clinical documentation completed by Behavioral Consultants (BC), Mobile Therapists (MT), and Behavioral Health Technicians (BHT) to ensure compliance with IBHS regulations, agency policies, and payer requirements. The IBHS Clinical Documentation Reviewer will ensure that progress notes are accurate, clinically appropriate, complete, and submitted within required timelines.

The IBHS Clinical Documentation Reviewer supports quality assurance efforts by identifying documentation deficiencies, providing corrective feedback, and promoting high standards of clinical documentation across the IBHS program.

Essential Duties & Responsibilities

Documentation Review

  • The IBHS Clinical Documentation Reviewer will review BC, MT, and BHT progress notes for accuracy, completeness, and compliance.
  • Ensure documentation reflects medical necessity, individualized interventions, and measurable progress toward treatment goals.
  • Verify that notes include objective observations, appropriate clinical language, and behaviorally specific interventions.
  • Monitor documentation for timeliness and completion according to agency and payer requirements.
  • Identify missing signatures, incomplete sections, inconsistencies, or compliance concerns.
  • Ensure interventions documented align with approved treatment plans and service authorizations.

Quality Assurance & Compliance

  • The IBHS Clinical Documentation Reviewer will conduct routine chart audits and documentation quality reviews.
  • Ensure compliance with:
    • Pennsylvania IBHS regulations
    • Medicaid and managed care standards
    • HIPAA confidentiality requirements
    • Agency documentation policies
  • Maintain tracking systems for documentation compliance and corrective actions.
  • Assist with preparation for audits, licensing reviews, and payer requests.

Staff Support & Feedback

  • The IBHS Clinical Documentation Reviewer will provide constructive feedback and recommendations to BCs, MTs, and BHTs regarding documentation improvements.
  • Collaborate with supervisors and clinical leadership to address recurring documentation issues.
  • Support staff training related to clinical documentation standards and best practices.
  • Communicate documentation deadlines and compliance expectations to staff as needed.

Qualifications

  • Masterโ€™s degree in Counseling, Social Work, Psychology, Human Services, or related field required.
  • Experience working within IBHS, behavioral health, or childrenโ€™s mental health services preferred.
  • Strong understanding of clinical documentation standards and behavioral health terminology.
  • Knowledge of IBHS regulations and medical necessity criteria preferred.
  • Excellent written communication, organization, and attention to detail.
  • Ability to work independently and meet deadlines.
  • Proficiency with electronic health records (EHR) systems and Microsoft Office.

Preferred Skills

  • Experience reviewing progress notes or conducting quality assurance audits.
  • Strong analytical and problem-solving skills.
  • Ability to provide professional and supportive feedback to staff.
  • Strong time management and organizational abilities.

Work Environment

  • In-person, office-based setting.
  • Frequent computer and documentation review work.
  • Collaboration with clinical and administrative teams.
  • Fast-paced behavioral health environment requiring professionalism and adaptability.

Benefits

  • Competitive salary
  • Paid time off
  • Professional development opportunities
  • Supportive team culture

Equal Opportunity Employer

Dunbar Wellness Group is an Equal Opportunity Employer committed to fostering an inclusive and supportive workplace for all employees.