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Medical Review Analyst Jobs (NOW HIRING)

Empower AI Inc.

Medical Review Specialist V

Responsibilities As a Medical Review Specialist V (Medical Reviewer V), you will review and analyze Medicare claims sampled by the Department of Justice, using associated medical records, to make ...

Empower AI Inc.

Responsibilities As a Medical Review Specialist V (Medical Reviewer V), you will review and analyze Medicare claims sampled by the Department of Justice, using associated medical records, to make ...

HealthPartners

Medical Review Investigator

Bloomington, MN · On-site

$29.57 - $44.35/hr

Primary responsibilities include evaluating allegations, analyzing claims data, reviewing medical records, conducting interviews, and performing investigative site visits. This role requires frequent ...

Empower AI Inc.

Responsibilities As a Medical Review Specialist V (Medical Reviewer V), you will review and analyze Medicare claims sampled by the Department of Justice, using associated medical records, to make ...

Empower AI Inc.

Medical Review Specialist V

Henrico, VA · On-site

Responsibilities As a Medical Review Specialist V (Medical Reviewer V), you will review and analyze Medicare claims sampled by the Department of Justice, using associated medical records, to make ...

Frost Bank

Asset Review Analyst I

San Antonio, TX · On-site

If so, being an Asset Review Analyst I with Frost could be for you. At Frost, it's about more than ... Medical, dental, vision, long-term disability, and life insurance * 401(k) matching * Generous ...

Valenz

Clinical Bill Review Analyst

Phoenix, AZ · Remote

Review medical bills to identify appropriate billing, coding, and savings opportunities. * Analyze and resolve claim discrepancies that require a deeper level of expertise beyond initial review.

Amerisbank

Digital Fraud Review Analyst

Atlanta, GA · On-site

The Digital Fraud Review Analyst is responsible for identifying potential fraudulent check deposits ... Medical, Dental and Vision Insurance * Ameris Bank absorbs a major portion of the cost of health ...

Frost Bank

Asset Review Analyst I

San Antonio, TX · On-site

If so, being an Asset Review Analyst I with Frost could be for you. At Frost, it's about more than ... Medical, dental, vision, long-term disability, and life insurance * 401(k) matching * Generous ...

Corvel

Bill Review Analyst I

$13.38 - $23.42/hr

The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for ... Knowledge of medical terminology, workers' compensation billing guidelines and fee schedules

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Medical Review Analyst information

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How much do medical review analyst jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for medical review analyst in the United States is $30.38, according to ZipRecruiter salary data. Most workers in this role earn between $20.43 and $36.06 per hour, depending on experience, location, and employer.

How to become a medical review analyst?

To become a medical review analyst, candidates typically need a bachelor's degree in healthcare, nursing, or a related field, along with experience in medical coding, billing, or clinical review. Strong analytical skills, attention to detail, and familiarity with medical records and insurance policies are essential; certifications such as Certified Professional Coder (CPC) or Certified Medical Review Officer (CMRO) can enhance job prospects.

What is a medical review analyst?

Medical Review Analysts are professionals who evaluate medical records, insurance claims, or healthcare data to ensure accuracy, compliance, and adherence to regulations and policies. They often work for insurance companies, healthcare providers, or government agencies, reviewing documents to determine if medical services are justified and properly documented. Their role is crucial in preventing fraud, ensuring proper billing, and supporting quality healthcare delivery. Medical Review Analysts must have a strong understanding of medical terminology, coding, and healthcare regulations.

What are some common challenges medical review analysts face when evaluating complex medical claims?

Medical Review Analysts often encounter challenges such as interpreting incomplete documentation, staying updated with evolving healthcare regulations, and ensuring compliance with payer guidelines. Analyzing complex or ambiguous medical records requires strong attention to detail and critical thinking skills. Collaboration with healthcare providers and other internal teams is frequently necessary to clarify information and support accurate decision-making. Successfully managing these challenges is crucial for maintaining the integrity of the claims review process and ensuring fair outcomes.

How much do medical review analysts make in the US?

Medical review analysts in the US typically earn an average salary ranging from $45,000 to $70,000 per year, depending on experience, location, and employer. Entry-level positions may start lower, while experienced analysts with certifications can earn higher salaries, often with opportunities for overtime and bonuses.

What is the difference between Medical Review Analyst vs Medical Claims Processor?

AspectMedical Review AnalystMedical Claims Processor
Required CredentialsTypically requires a healthcare-related certification or background, such as a nursing license or medical coding certificationUsually requires basic high school diploma or equivalent; some roles prefer medical billing or coding certification
Work EnvironmentOffice setting, reviewing medical records and claims, often involving detailed analysisOffice setting, processing and entering claims data, handling administrative tasks
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare providersHealth insurance companies, healthcare providers, billing companies

The Medical Review Analyst focuses on evaluating medical records and claims for accuracy and compliance, often requiring healthcare credentials. In contrast, Medical Claims Processors primarily handle the administrative processing of claims, with less emphasis on clinical knowledge. Both roles are essential in the healthcare insurance industry but differ in responsibilities and required qualifications.

What are the key skills and qualifications needed to thrive as a medical review analyst?

To thrive as a Medical Review Analyst, you need a solid understanding of medical terminology, healthcare regulations, and clinical documentation, usually supported by a degree in a health-related field or nursing. Familiarity with medical coding systems (such as ICD-10 and CPT), claims management software, and regulatory compliance tools is essential. Attention to detail, analytical thinking, and strong written communication skills distinguish top performers in this role. These skills ensure accurate evaluation of medical claims, compliance with industry standards, and effective communication with healthcare providers.
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Medical Review Analyst jobs near you
Infographic showing various Medical Review Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $63,187 per year, or $30.4 per hour.

Medical Review Specialist V

Empower AI Inc.

Remote

Other

Re-posted 14 days ago

Job description

Overview
Empower AI is AI for government. Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. Our proven Empower AI Platform® provides a practical, sustainable path for clients to achieve transformation that is true to who they are, what they do, how they work, with the resources they have. The result is a government workforce that is exponentially more creative and productive. For more information, visit www.Empower.ai.
Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs. This designation reflects the company's commitment to hiring and supporting active-duty and veteran employees.
Responsibilities
As a Medical Review Specialist V (Medical Reviewer V), you will review and analyze Medicare claims sampled by the Department of Justice, using associated medical records, to make payment determinations based on coverage, coding and utilization of services and practice guidelines. This is a casual/part time position.
  • Conducts medical record claims review to determine correct coding, utilizing ICD-9-CM, ICD-10, CPT-4, and HCPCS Level II coding principles. Review medical documentation for medical necessity utilizing clinical knowledge and Center for Medicare Services (CMS) policies and guidelines, as well as other state and board regulations.
  • Conducts in-depth claims analysis of suspected over-utilizers who are suspect of fraudulent billing practices, including analysis of Standard Claims Processing files to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicare and/or Medicaid payment policies
  • Completes summary report upon completion of the records review, summarizing claim determinations, clinical observations and other information requested by the DOJ based on the review of medical records
  • Reviews and completes the required number of claims reviews in accordance to pre-established production standards for the project
  • Produces and submits required reports according to established content and timeframes
  • Communicates internally with all levels of the group
  • Participates in Quality Assurance (QA) and IRR monitoring as requested
  • Complies with departmental policies and procedures
  • Complies with Medicare and DOJ guidelines and CMS directives, policies and regulations pertaining to integrity, fraud, overpayments, and the handling and disclosure of information
  • Attends departmental and required education and training programsReviews information contained in Standard Claims Processing System to determine provider billing patterns and to detect potentially fraudulent or abusive billing practices or vulnerabilities in Medicare payment policies
  • Utilizes the Medicare/Medicaid guidelines for coverage determinations
  • Performs in-depth research and investigation using the Internet and other tools, including data analysis tools
  • Maintains chain of custody on all documents, follows all confidentiality and security guidelines and completes assignments in a manner that meets or exceeds the contract quality assurance goals

Qualifications
Requirements:
  • Registered Nurse (RN) (Bachelors, Associate's degree or diploma-based)
  • Current licensure as a Registered Nurse in one or more of the 50 states or D.C.
  • Excellent oral and written communication skills
  • Organization and time management skills
  • Knowledge of and ability to use Microsoft Excel and word, Adobe PDFs and various internet applications
  • At least 10 years of clinical experience
  • Minimum seven (7) years claims knowledge either from billing, reviewing, or processing.
  • Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program and must have no conflict of interest (COI) as defined in Section 1154(b)(1) of the Social Security Act
  • Medical review experience required
  • Previous fraud review/ investigation experience preferred
  • Ability to keep sensitive and confidential material private.

Physical Requirements:
This position requires the ability to perform the below essential functions:
  • Sitting for long periods

About Empower AI
All hiring and promotion decisions at Empower AI are based on merit to bring the best talent available to contribute to our firm's overall success. It is the policy of Empower AI not to discriminate against any applicant for employment, or employee because of age, color, sex, disability, national origin, race, religion, or veteran status. Empower AI is a VEVRAA Federal Contractor.

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