Jobs at MedReview

Coordinates and resolves nonclinical healthcare appeals, grievances, complaints, and provider inquiries. Responsibilities include researching cases, preparing external review and state hearing files, tracking deadlines, determining outcomes, drafting responses, consulting clinical and operational teams, and ensuring compliance with timeliness and accuracy standards. The role requires healthcare industry experience, knowledge of claims payment methodology, strong analytical and communication skills, and proficiency with Excel and WebStrat.

The SFTP Analyst will manage and support enterprise SFTP/MFT platforms, troubleshoot production issues, and automate tasks in high-availability environments.

Manage the full procure-to-pay lifecycle: process high-volume vendor invoices, route approvals, execute payments, reconcile statements, support month-end close and 1099 reporting. Maintain vendor records, resolve discrepancies, administer Concur expense workflows and corporate cards, and help drive AP process improvements.

Design, deploy, and secure scalable cloud network infrastructure. Manage cloud networking, firewalls, access controls, monitoring, and compliance (PI/PHI). Automate with scripting/Ansible, troubleshoot performance issues, and maintain documentation while collaborating with DevOps and IT teams.

The DevOps Engineer streamlines software development and IT operations through automation, manages CI/CD processes, and ensures system reliability. They collaborate with various teams and troubleshoot issues, enforcing compliance and optimizing environments.

The Physician Reviewer will evaluate complex hospital cases for DRG validation, ensure accurate documentation, and contribute to quality assurance initiatives.

The Data Scientist will analyze complex datasets, develop predictive models, and collaborate with stakeholders to drive data-driven decisions.

Lead enterprise data function, oversee data architecture and engineering, ensure quality and compliance of healthcare data, manage teams, and develop scalable data solutions on Azure.

The Data Engineer will design and maintain data pipelines on Azure, manage ClickHouse for analytics, and ensure healthcare compliance while supporting ML integration.

The ETL Engineer will design, develop, and optimize ETL pipelines using tools like Azure Data Factory and ClickHouse, ensuring performance and reliability while integrating data from various sources.

The Business Analyst will work with stakeholders to document requirements and analyze healthcare claims data to improve payment integrity operations.

Triage and process facility-submitted appeals (administrative and clinical when no new information), determine decisions per client/org policies, coordinate escalations with clinical teams, communicate with stakeholders, and ensure timely, accurate appeal resolutions while managing a high-volume caseload.

Perform inpatient claim reviews to validate ICD-10-CM/PCS coding and correct DRG assignment per Official Coding and Reporting Guidelines, collaborate with physician reviewers, meet productivity and accuracy targets, and maintain required coding credentials and continuing education.