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Medical Review Analyst Jobs (NOW HIRING)

Ampcus

Clinical Medical Review Nurse

Baltimore, MD · On-site

Clinical Medical Review Nurse. Location: Baltimore, MD. Purpose: * The Clinical Medical Review ... This position assists in determining acceptable medical risk to the organization by analyzing ...

Corvel

Bill Review Analyst I

Folsom, CA · Remote

$13.38 - $23.42/hr

The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote position ESSENTIAL FUNCTIONS ...

New

Valenz Health

Clinical Bill Review Analyst

Phoenix, AZ · On-site +1

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.

Corvel

Bill Review Analyst I

Folsom, CA · On-site

$13.38 - $23.42/hr

The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote position ESSENTIAL FUNCTIONS ...

New

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 ... Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State ...

TEKsystems

Credit Risk Review Analyst

Manhattan, NY

$32 - $38/hr

Analyze credit exposures and recommend risk mitigation strategies across covered sectors. Partner ... If eligible, the benefits available for this temporary role may include the following: • Medical ...

RELI GROUP INC

Medical Review Nurse III

Baltimore, MD · Remote

Compile a report of analysis and recommendations to submit to CMS. * Perform New Issue Quality ... Report problems to the Medical Review Manager (MRM) and Project Manager (PM) regarding unique ...

TEKsystems

Credit Risk Review Analyst

Manhattan, NY

$32 - $38/hr

Analyze credit exposures and recommend risk mitigation strategies across covered sectors. Partner ... If eligible, the benefits available for this temporary role may include the following: • Medical ...

Empower AI

Medical Reviewer III (Medicare/DME)

Performs first and second level of Medical Review in determination of claims payment review * Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles

Abbott

Medical Review Officer (MRO)

Kansas City, KS

Reviews and interprets drug test results, including determining legitimate medical explanations in ... Strong analytical, communication, and problem-solving capabilities. * Proficiency in Microsoft ...

Empower AI

Medical Reviewer III (Medicare/DRG)

Performs first level of Medical Review in determination of claims payment review. * Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles. * Utilize ...

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

Compile a report of analysis and recommendations to submit to CMS. * Perform New Issue Quality ... Report problems to the Medical Review Manager (MRM) and Project Manager (PM) regarding unique ...

Abbott

Medical Review Officer (MRO)

Reviews and interprets drug test results, including determining legitimate medical explanations in ... Strong analytical, communication, and problem-solving capabilities. * Proficiency in Microsoft ...

Empower AI Inc.

Performs first level of Medical Review in determination of claims payment review * Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles * Utilize ...

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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.

Clinical Medical Review Nurse

Ampcus

Baltimore, MD • On-site

Other

Re-posted 18 days ago

Job description

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team. Job Title: Clinical Medical Review Nurse. Location: Baltimore, MD. Job Description: Purpose:
  • The Clinical Medical Review Nurse handles day-to-day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication.
  • The incumbent will handle pre and post claim medical review for Commercial, FEP and Medicare Advantage Plans.
  • This position assists in determining acceptable medical risk to the organization by analyzing medical information of applicants for enrollment in specific policies.
  • This role will also understand the merits of legal or accreditation actions.
Essential Functions:
  • 35% Receives, research, reviews and analyzes professional and institutional claims using critical thinking, nursing clinical judgment and corporate/medical policies for claims processing and/or adjudication, performs high-level research on topics identified as actual or potential medical policies. Assesses and communicates impact of information on medical policy.
  • 25% Provides pricing of procedure codes which require individual consideration or are listed as "not otherwise classified" in CPT manual. Interprets the descriptive or medical information utilizing the CPT and HCPCS manuals. Keeps up to date on coding rules and standards.
  • 25% Participates in medical policy meetings, nurses' forums, and review sessions with Medical and Dental directors, special projects and task forces committees as assigned.
  • 15% Performs medical underwriting and risk assessment by reviewing applications of potential subscribers, as well as any appropriate medical records.
Qualifications:
  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
  • The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Knowledge, Skills and Abilities (KSAs):
  • Ability to effectively communicate and provide positive customer service to every internal and external customer, Proficient.
  • Strong interpersonal skills. Ability to work independently, as well as a member of a team, Advanced.
  • Current knowledge of clinical practices and related medical policies., Proficient.
  • Strong organizational skills, ability to prioritize responsibilities with attention to detail., Proficient.
  • Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and web-based technology., Proficient.
  • Must possess excellent verbal and written communication skills. Advanced.
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.
  • Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
  • Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Preferred Qualifications:
  • Bachelor's degree in nursing.
Experience:
  • 3 years acute clinical experience, previous case management, discharge planning or utilization review experience.
Licenses/Certifications:
  • RN - Registered Nurse - State Licensure And/or Compact State Licensure RN-VA, DC and or MD Upon Hire required.
Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.
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About Ampcus

Sourced by ZipRecruiter

Ampcus Inc. is a ISO 20000, ISO 27000, ISO 9001, CMMI DEV/3 SM and CMMI SVC/3 SM certified global provider of a broad range of Technology and Business consulting services. From strategy to execution, our disciplined yet flexible approach starts and ends with our clients. By listening hard and working harder, client goals become our goals. Their success is our satisfaction. It’s why our clients sleep well at night. We believe that the success of an engagement is determined by strong project management, as well as clear communication and mutual commitment working collaboratively. Our methodology begins with listening to the customer about their needs, then working with their team to gain a clear understanding of the requirements, while providing knowledge transfer of best practices for the organization.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Chantilly, VA, US

Year founded

2004

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