* Organize and prioritize assigned reviews to make payment determinations in accordance with coding guidelines and medical policies, utilizing expertise in CDT, CPT, ICD, DRG, REV, and HCPCS coding to ...
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* Organize and prioritize assigned reviews to make payment determinations in accordance with coding guidelines and medical policies, utilizing expertise in CDT, CPT, ICD, DRG, REV, and HCPCS coding to ...
Associate Director, Medical Review Lead, MSRM Who we are: At Agios, we are fueled by connections to transform rare diseases. We foster an inclusive, collaborative culture - one that sparks bold ...
Associate Director, Medical Review Lead, MSRM Who we are: At Agios, we are fueled by connections to transform rare diseases. We foster an inclusive, collaborative culture - one that sparks bold ...
Administrative Assistant - Medical Review Support
Atlanta, GA · On-site
$17.75 - $23.25/hr
Administrative Assistant - Medical Review Support Duration: 3 Years Location: 241 Ralph McGill Blvd NE, Atlanta, GA 30308 Client: Georgia Power Position Summary The Administrative Coordinator ...
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Administrative Assistant - Medical Review Support
Atlanta, GA · On-site
$17.75 - $23.25/hr
Administrative Assistant - Medical Review Support Duration: 3 Years Location: 241 Ralph McGill Blvd NE, Atlanta, GA 30308 Client: Georgia Power Position Summary The Administrative Coordinator ...
About MMRO Managed Medical Review Organization (MMRO) is an established, URAC-accredited Independent Review Organization (IRO) that provides objective, evidence-based medical peer reviews nationwide.
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About MMRO Managed Medical Review Organization (MMRO) is an established, URAC-accredited Independent Review Organization (IRO) that provides objective, evidence-based medical peer reviews nationwide.
OR · On-site
The Senior Manager, Medical Review Operations is responsible for driving operational excellence and strengthening community coordination and cross-functional collaboration across Medical Affairs and ...
Medical Review Analyst II
Norfolk, VA · On-site
$22.50 - $40.51/hr
Medical Review Analyst II Location : Any Elevance Health PulsePoint. Ideal candidate will reside within commutable distance to Norfolk, VA; Costa Mesa, CA; or Grand Prairie, TX. Virtual : This role ...
Medical Review Analyst II
Norfolk, VA · On-site
$22.50 - $40.51/hr
Medical Review Analyst II Location : Any Elevance Health PulsePoint. Ideal candidate will reside within commutable distance to Norfolk, VA; Costa Mesa, CA; or Grand Prairie, TX. Virtual : This role ...
Serves as the Medical Review and Prior Authorization liaison between internal and external stakeholders. Description Why should you join the BlueCross BlueShield of South Carolina family of companies?
Serves as the Medical Review and Prior Authorization liaison between internal and external stakeholders. Description Why should you join the BlueCross BlueShield of South Carolina family of companies?
The Associate Director, Medical Review, will serve as a functional expert in the area of Medical Review for their assigned region and products and ensure alignment and integration of process and ...
The Associate Director, Medical Review, will serve as a functional expert in the area of Medical Review for their assigned region and products and ensure alignment and integration of process and ...
Medical Review Analyst II
Los Angeles, CA · On-site
$22.50 - $40.51/hr
Medical Review Analyst II Location : Any Elevance Health PulsePoint. Ideal candidate will reside within commutable distance to Norfolk, VA; Costa Mesa, CA; or Grand Prairie, TX. Virtual : This role ...
Medical Review Analyst II
Los Angeles, CA · On-site
$22.50 - $40.51/hr
Medical Review Analyst II Location : Any Elevance Health PulsePoint. Ideal candidate will reside within commutable distance to Norfolk, VA; Costa Mesa, CA; or Grand Prairie, TX. Virtual : This role ...
Serves as the Medical Review and Prior Authorization liaison between internal and external stakeholders. Description Why should you join the BlueCross BlueShield of South Carolina family of companies?
Serves as the Medical Review and Prior Authorization liaison between internal and external stakeholders. Description Why should you join the BlueCross BlueShield of South Carolina family of companies?
Serves as the Medical Review and Prior Authorization liaison between internal and external stakeholders. Description Why should you join the BlueCross BlueShield of South Carolina family of companies?
Serves as the Medical Review and Prior Authorization liaison between internal and external stakeholders. Description Why should you join the BlueCross BlueShield of South Carolina family of companies?
As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis ...
As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis ...
Medical Review RN * Date: Start Date - TBD * Shift Time: 0800-1630 M-F * Location: Washington, DC Position Summary: LifeHealth Medical Review Nurse (MRN) is responsible for the initial chart review ...
Medical Review RN * Date: Start Date - TBD * Shift Time: 0800-1630 M-F * Location: Washington, DC Position Summary: LifeHealth Medical Review Nurse (MRN) is responsible for the initial chart review ...
As a casual Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for ...
As a casual Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for ...
As a casual Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for ...
As a casual Medical Review Specialist III (Medical Reviewer III) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for ...
Medical Reviewer
Wallingford, CT · On-site
$174K - $249K/yr
Under the general direction of the Vice President of Clinical Affairs, performs medical case review of services subject to approval under the Connecticut Medical Assistance Program (CMAP)
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Medical Reviewer
Wallingford, CT · On-site
$174K - $249K/yr
Under the general direction of the Vice President of Clinical Affairs, performs medical case review of services subject to approval under the Connecticut Medical Assistance Program (CMAP)
As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis ...
As a casual Medical Review Specialist III (Medicare DRG) for Empower AI, Inc., you will perform Medicare comprehensive medical record and claims review to make payment determinations for Diagnosis ...
Supervise Medical Review personnel within the therapeutic area across the global team, including physicians and scientists. * Build deep regulatory and technical expertise through recruitment ...
Supervise Medical Review personnel within the therapeutic area across the global team, including physicians and scientists. * Build deep regulatory and technical expertise through recruitment ...
Medical Review Officer (MRO)
Kansas City, KS · On-site +1
Reviews and interprets drug test results, including determining legitimate medical explanations in accordance with federal regulations. * Ensures compliance with specimen collection procedures, chain ...
New
Medical Review Officer (MRO)
Kansas City, KS · On-site +1
Reviews and interprets drug test results, including determining legitimate medical explanations in accordance with federal regulations. * Ensures compliance with specimen collection procedures, chain ...
New
As a casual Medical Review Specialist III (Medical Reviewer III) you will primarily perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare PART A.
As a casual Medical Review Specialist III (Medical Reviewer III) you will primarily perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare PART A.
Medical Review information
See salary details
$62.2K is the 25th percentile. Wages below this are outliers.
$36.5K - $63.8K
27% of jobs
The median wage is $89.9K / yr.
$63.8K - $91.1K
24% of jobs
$91.1K - $118.5K
4% of jobs
$118.5K - $145.8K
3% of jobs
$145.8K - $173.1K
2% of jobs
$173.1K - $200.4K
1% of jobs
$200.4K - $227.7K
3% of jobs
$227.7K - $255K
6% of jobs
$261K is the 75th percentile. Wages above this are outliers.
$255K - $282.4K
17% of jobs
$282.4K - $309.7K
7% of jobs
$309.7K - $337K
4% of jobs
$36.5K
$164.7K
$337K
How much do medical review jobs pay per year?
As of Jun 12, 2026, the average yearly pay for medical review in the United States is $164,731.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,000.00 and $268,500.00 per year, depending on experience, location, and employer.
What are the key skills and qualifications needed to thrive as a Medical Reviewer, and why are they important?
To thrive as a Medical Reviewer, you need a strong understanding of clinical medicine, scientific research, and regulatory guidelines, often supported by a medical degree or advanced healthcare qualification. Familiarity with medical databases, regulatory submission systems, and tools like MedDRA coding or CTD formatting is typically required. Attention to detail, analytical thinking, and effective written communication are essential soft skills for reviewing complex documents and collaborating with multidisciplinary teams. These skills ensure accurate, compliant, and high-quality medical evaluations that support regulatory approvals and patient safety.
What is medical review?
Medical review refers to the process of evaluating medical information, records, or claims to ensure accuracy, compliance, and appropriateness based on clinical guidelines and policies. Professionals in medical review often assess documentation for insurance claims, pre-authorization requests, or clinical trials. Their work helps ensure that patients receive appropriate care and that healthcare providers follow industry standards.
How does a Medical Review professional typically collaborate with other departments within a healthcare or insurance organization?
Medical Review professionals frequently work closely with clinical staff, claims adjusters, and compliance teams to ensure that medical records and claims are accurately assessed and meet regulatory standards. Collaboration often involves discussing complex cases, clarifying clinical documentation, and providing guidance on policy interpretation. Effective communication and teamwork are essential, as Medical Review staff often act as a bridge between medical and administrative teams to support fair and thorough claims processing.
What is the difference between Medical Review vs Medical Coding Specialist?
| Aspect | Medical Review | Medical Coding Specialist |
|---|---|---|
| Required Credentials | Medical degree or clinical background, certifications like CCM or CRC | Certification in coding (CPC, CCS), knowledge of coding systems |
| Work Environment | Healthcare facilities, insurance companies, telehealth | Hospitals, clinics, insurance companies, remote coding |
| Employer & Industry Usage | Used to assess medical necessity, compliance, and documentation | Used to assign billing codes based on medical records |
Medical Review involves evaluating medical records for accuracy, compliance, and appropriateness, often requiring clinical expertise. Medical Coding Specialists focus on translating medical documentation into standardized codes for billing and insurance purposes. While both roles require healthcare knowledge, Medical Review emphasizes clinical assessment, whereas Medical Coding centers on coding accuracy for reimbursement.
More about Medical Review jobs
What cities are hiring for Medical Review jobs? Cities with the most Medical Review job openings:
What are the most commonly searched types of Medical Review jobs? The most popular types of Medical Review jobs are:
What states have the most Medical Review jobs? States with the most job openings for Medical Review jobs include:
Full-time
Posted 5 days ago
Job description
Organize and prioritize assigned reviews to make payment determinations in accordance with coding guidelines and medical policies, utilizing expertise in CDT, CPT, ICD, DRG, REV, and HCPCS coding to identify and address potential healthcare fraud schemes.
Perform reviews of (pre-payment or post-payment) medical records and healthcare claims, determining the accuracy of codes billed and compliance with appropriate policies, procedures, and regulations.
Conduct medical policy and other research relevant to allegations and healthcare claims, determining the accuracy of codes billed and compliance with appropriate policies, procedures, and regulations.
Document and prepare well-articulated reports of medical review findings, highlighting key concerns, potential overpayments, and recommendations for payers/clients.
Effectively communicate findings to internal teams/leadership and actively support client interactions under supervision.
Participate in provider education calls to support medical review findings.
Assist in legal proceedings, including testifying and providing evidentiary support for medical review outcomes.
Analyze existing policies and processes to identify inefficiencies and propose actionable improvements.
Keep up to date with relevant regulations and standards, including federal policies and coding guidelines.
Actively engage and support all other projects assigned.
Maintain confidentiality and discretion in all medical review/investigative activities.