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.

View 30 Popular Schools »

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.

Job Duties

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.

Certification

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.

Show me popular schools

Related to Medical Reviewer: Job Description, Duties and Requirements

  • Related
  • Recently Updated
  • Popular
Best Colleges for Surgeons: List of Top Medical Schools

Surgical programs at the country's top medical schools prepare students for careers as general surgeons or as surgeons...

Top Schools for Medical Ethics and Bioethics

Professionals working in the medical ethics and bioethics field address controversial ethical issues related to...

Become a Medical Editor: Step-by-Step Career Guide

Learn how to become a medical editor. Research the job duties and the education requirements and find out how to start...

Medical Technician - EMT - Paramedic Career Education Overview

Emergency medical technicians are the personnel who help stabilize patients before they reach the hospital. A...

Be a Chief Medical Examiner: Career Advancement Guide

30 Popular Schools

Popular Schools

Avg. Wages For Related Jobs

Source: Bureau of Labor Statistics