Medical Reviewer: Job Description, Duties and Requirements
Medical reviewers perform audits on all medical records contained in a health care facility. Also known as medical auditors, they review the data to ensure the accuracy of the record as well as assess the quality of patient care. Medical reviewers must complete at least a 2-year associate degree through a technical school or community college.
Medical Reviewer Job Description
Medical reviewers work in hospitals, physician offices, nursing homes and for independent auditing firms. They review or audit medical records for completeness and accuracy by looking at various pieces of documentation. Incorrect or missing documentation can result in loss of hospital accreditation, a physician's license or Medicare status. The facility will also lose reimbursement from an insurance company, Medicare or Medicaid. Too many mistakes in documentation can result in a facility closing.
Medical reviewers often coordinate in-service meetings to educate the medical staff on proper documenting procedures. They also keep abreast of new coding, government and insurance guidelines.
Medical reviewers look at each individual medical record to check for missing documentation; they also check for physician's notes that show any evidence of patient neglect or abuse and verify that the correct member of staff has signed all paperwork. When the reviewer finds a problem with the record, a citation is issued to the medical staff member. The member is given a set time period to fix the mistake. A follow-up conducted by the reviewer is done to ensure the record is up to compliance.
Requirements for a Medical Reviewer
Medical reviewer training might begin with an Associate of Applied Science in Health Information Technology program; this degree prepares graduates to become Registered Health Information Technicians (RHITs), a designation that employers sometimes require for medical reviewer positions. While in the program, students study such courses as anatomy, medical terminology, computer applications, medical record analysis and medical law. Toward the end of the program, students are required to complete an externship either in a hospital or at a physician's office.
Other degree programs that can prepare candidates for medical reviewer positions include health care management and nursing. Some medical reviewers are registered nurses (RNs) with additional training in medical coding.
After graduation, individuals can sit for their Certified Professional Medical Auditor (CPMA) credential through the American Academy of Professional Coders (AAPC). According to the AAPC, the 5-hour exam consists of 150 multiple choice questions, including sample audits for over 20 health care cases (www.aapc.com). The exam covers such areas as medical record standards, reimbursement concepts, medical statistics, medical record auditing practices and medical law.
Related to Medical Reviewer: Job Description, Duties and Requirements
- Recently Updated
Surgical programs at the country's top medical schools prepare students for careers as general surgeons or as surgeons...
Professionals working in the medical ethics and bioethics field address controversial ethical issues related to...
Learn how to become a medical editor. Research the job duties and the education requirements and find out how to start...
Emergency medical technicians are the personnel who help stabilize patients before they reach the hospital. A...
- Open Education Around the World: Education Portal Speaks with Taipei Medical University
- The Doctor Is In(ternational): Foreign Medical Schools and U.S. Hospitals
- Medical Translation Certificate and Education Program Info
- Top Business School for a Sales and Marketing Degree - Chicago, IL
- Top Degree Programs for a Respiratory Therapist - Phoenix, AZ
- Top School for a Master's Degree in Healthcare Management - Charlotte, NC
- Top Ranked School for the Medical Assisting Field - Atlanta, GA
- How to Become a Medical Underwriter: Career Guide
- Types of Medical Assistants: Career Info by Specialization
- Top School for a Degree in Computer Information Technology - Columbus, OH
- Top Ranked University for a Business Accounting Degree - Dallas, TX
- Top Degrees for Multimedia and Computer Graphics Design - Phoenix, AZ