MedReview

At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier, and Readmission reviews.

Requirements

• Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems, adjudication platforms, policies, and procedures.
• Support to various departments related to claim status, claim adjudication questions, and any basic questions related to the adjudication of an inpatient medical claim.
• Reviewing data in the review application and client claim processing system, and comparing with corresponding UB, medical record or other documentation.
• Reviewing all necessary documentation as necessary to determine appropriate reimbursement for a claim.
• Reviewing adjudication software system’s claim and line items for determination of how to price a claim / line item.