MedReview

Title: Cloud Network & Security Engineer Location: Newport Beach, CA Job Description: Position Summary: MedReview is looking for a skilled Cloud Network & Security Engineer to join our team and play a key role in designing, optimizing, and securing our cloud infrastructure. This position is critical to ensuring scalability, performance, and compliance across our environment. This position is based in our Newport Beach, CA office Monday through Thursday, with Fridays remote. The salary range for this role is $140,000-150,000 depending upon experience Responsibilities: - Design and implement scalable cloud network solutions - Manage and deploy end-to-end cloud infrastructure (multi-tenancy, virtualization, orchestration) - Leverage automation tools like Python and Ansible to improve efficiency - Monitor network performance, troubleshoot issues, and ensure high availability - Implement and maintain security protocols to protect sensitive data (PI/PHI) - Manage firewalls, access controls, and network configurations - Collaborate cross-functionally with DevOps developers, and IT teams - Maintain documentation for network configurations and policies Required Skills: - 4-7 years of experience in networking engineering with a strong focus on cloud environments - Hands-on experience with Azure (AWS or GCP also considered) - Strong knowledge of networking protocols (BGP, OSPF, EIGRP, VLAN, STP) - Experience with security and monitoring tools (e.g., Splunk, SolarWinds, Zabbix, CrowdStrike) - Familiarity with HIPPA, HITRUST, or other compliance frameworks - Experience with firewalls (Palo Alto, Fortinet) and load balancers - Scripting/automation experience (Python, Ansible, PowerShell) - Strong troubleshooting and problem-solving skills - Relevant certifications (CCNP, Azure/AWS/GCP) are a plus

Title: DRG Clinical Validation Nurse Location: Remote Full-time Mid Level Job Description: Position Summary 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. We are seeking a registered nurse with experience in clinical validation to work within our coding department. Candidate should be highly motivated, with strong clinical and coding background. This individual must have excellent communication skills and an analytical mindset to achieve and maintain high-level performance in a fast-paced environment. This is a fulltime position (40 hours per week) Monday – Friday. You’ll enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home. If you are interested in this role with MedReview, please let us know. Here is what we are searching for: Responsibilities: - Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record - Must be able to interpret clinical guidelines/criteria and apply to clinical review - Solid understanding of anatomy and physiology, diagnostic and surgical procedures developed from specialized training and extensive experience with ICD-10-PCS code assignments - Demonstrates the ability to accurately interpret the medical record - Writes clear, accurate and concise rationales in support of findings - Maintains and manages case reviews with a high emphasis on quality - Demonstrates the ability to work in a high – volume production environment - Knowledge of health insurance business, industry terminology, and regulatory guidelines Qualifications: - Minimum of two years’ experience in clinical validation in a payment integrity setting required - May consider nurses with inpatient claims auditing experience or case management experience. - Unrestricted Registered Nurse with active RN licensure required - CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification preferred - CCDS or CDIP Certification preferred - Knowledge of ICD-10 coding - Basic Knowledge of DRG validation and coding - Ability to use Windows PC with the ability to utilize multiple applications at the same time Remote Work Requirements - High speed internet (100 Mbps per person recommended) with secured WIFI. - A dedicated workspace with minimal interruptions to protect PHI and HIPAA information. - Must be able to sit and use a computer keyboard for extended periods of time. Benefits and perks include: - Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents. - 401(k) with Employer Match - Join the team and we will invest in your future - Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays. - Wellness - We care about your well-being. From Commuter Benefits to FSAs, we’ve got you covered. - Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional. Salary Rate: $85,000 – 95,000/Annually.

Role Description As a Data Mining Ideation Specialist, you will leverage your deep expertise in medical coding requirements, claims adjudication processes, and reimbursements methodologies to design and develop data mining audits that drive payment accuracy across our clients' Medicaid, Medicare, and Commercial lines of business. This role is ideal for someone who thrives at the intersection of coding, analytics, and audit development. - Translate complex reimbursement policies into actionable audit concepts that identify improper payments with a high degree of precision and consistency. - Apply strong analytical thinking, an in-depth understanding of claims data, and meticulous attention to detail to uncover overpayment opportunities and build scalable audit logic. - Define data selection parameters, validate outcomes, and continuously refine audit strategies to improve accuracy and impact. - Support production audit teams through training, guidance, and ongoing quality initiatives. This is a remote role. Salary Range 80-100K depending upon experience. Qualifications - 5+ years of complex claims processing and/or coding auditing experience in the health insurance industry. - Knowledge of all payer types including Medicare, Medicaid, and Commercial plans. - Prior experience in payment integrity audit development is highly preferred. - Mastery of CPT, HCPCS, and ICD coding standards. - Current Coding Certification: - AAPC Certified Professional Coder (CPC), Certified Outpatient Coder (COC) certification, or - Certified Coding Specialist (CCS) certification through AHIMA or - RHIT designation - Expert level understanding of medical claim coding and its impact on claim payments. - Ability to develop data mining audits, apply regulatory standards, and contractual requirements with credibility and objectivity. - Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation. - Knowledge of health insurance operations, specifically with claims processing, billing, reimbursement, or provider contracting. - Prior experience in payer edit development, and/or reimbursement policy experience. - Expertise in data analysis and EXCEL. - Strong analytical and problem-solving abilities. - Effective communication skills. - Meticulous attention to detail. Requirements - Python or SQL coding skills. - Clinical background or experience. - Demonstrated experience translating technical jargon to non-technical end users. - Previous experience in the Payment Integrity space. - Exposure to EDI transactions (837, 835). - Experience using coding tools (such as 3M, Webstrat, and Encoder). - Collaborative mindset and ability to work effectively across cross-functional teams. - Proficiency in Outlook, Word, Excel, and other applications. - Ability to work independently and can multi-task or transition to different tasks easily. What Success Looks Like - Develop and deliver 6+ new audit concepts monthly, including logic specifications aligned with reimbursement policies. - Submit 4+ high-impact audit concepts per month, contributing to a minimum of $975K in identified overpayment opportunities. - Partner with internal teams to move concepts from ideation to client review and production implementation. - Ensure timely communication and follow-through: - Respond to inquiries within 1 business day. - Complete research and provide updates within 3 business days. - Drive resolution, including logic revisions or claim actions, within 5 business days. - Monitor audit performance, including yield and appeal outcomes, and continuously refine logic for accuracy and impact. - Collaborate with Operations and Management to support audit effectiveness and quality initiatives. - Complete "Second Look" reviews within established turnaround times.

Position Summary: MedReview is looking for a talented and experienced Data Scientist to join our dynamic team. As a part of our team, you will leverage your analytical skills and expertise in machine learning to extract insights from complex datasets and drive data-driven decision-making across our organization. You will collaborate closely with cross-functional teams to develop predictive models, uncover actionable insights, and solve challenging business problems. As part of a global team of developers and analysts, the Data Scientist will work with a larger team to design, build, validate, refine, and operationalize models. This position will sit in Austin, Texas. However, for the right fit, we may consider remote. Responsibilities: - Problem Identification: Collaborate with stakeholders to identify business challenges that can be solved through data analysis. - Data Collection & Preparation: Gather data from various sources (SQL databases, APIs, web scraping), then clean and "wrangle" it to ensure accuracy for modeling. - Model Development: Design and implement algorithms and predictive models using machine learning techniques to forecast outcomes or categorize information. - Exploratory Data Analysis (EDA): Analyze datasets to uncover hidden patterns, trends, and anomalies. - Communication & Visualization: Translate technical findings into "data stories" using tools like Tableau or Power BI to influence executive decisions. Qualifications: - Master’s degree or bachelors degree and equivalent experience in a quantitative field (Math, CS, Stats) - Programming: Proficiency in Python or R along with SQL for database querying. - Mathematics & Statistics: Strong foundation in linear algebra, calculus, and statistical modeling. - Machine Learning: Experience with frameworks like TensorFlow, PyTorch, or scikit-learn. Soft Skills: Critical thinking, curiosity, and the ability to explain complex concepts to non-technical audiences. Experience working with global and remote teams

Position Summary: The Senior Director – Coding Operations is responsible for management and delivery fulfillment for MedReview’s team of certified coders and support staff. We are seeking either a certified coder or registered nurse with extensive experience in both inpatient coding and clinical validation. The Sr. Director oversees a team of in-house, offshore and vendor coders totaling 75+ employees. This position is responsible for ensuring client and internal deliverables are achieved through active management of production quotas, process optimization, quality assurance, onboarding/training, staffing, and inventory management. The ideal candidate for this role is an experienced payment integrity coding leader who has successfully managed people and processes in a high growth, fast paced environment. A successful candidate has experience identifying and implementing process optimization changes while concurrently meeting operational goals. This position is an operational leader, and a focus on production, quality, staff time management and data driven decision-making is critical. Candidates must be highly motivated and possess a strong clinical and coding background. This individual must have excellent communication skills and an analytical mindset to achieve and maintain high-level performance in a fast-paced environment. This is a fulltime position (40 hours per week) Monday – Friday. You’ll enjoy the flexibility to telecommute from anywhere within the United States. Responsibilities: - Develops and directs strategic growth and operational objectives including productivity and quality standards. Integrates services and strategic plans with the mission, vision, and values of MedReview. - Demonstrates the ability to think both critically and independently when encountering complex claim scenarios. - Uses decisive judgement and the ability to work with minimal supervision. Must be able to work in a fast-paced environment and take appropriate action when needed. - Develop and empower management team to lead daily operations, resolve issues, manage employee performance, manage physician relations, and ensure operational efficiencies. - Establish and enforce coding performance metrics, monitor team performance, and implement strategies for continuous improvement. - Serve as an expert resource for coding-related queries and provide expertise regarding complex coding claim scenarios. - Prepare and present regular reports on coding accuracy, compliance, and productivity to executive leadership. - Navigate the MedReview proprietary system daily to trouble shoot escalated claim issues. - Monitor coding claim volume daily within the MedReview proprietary claims management system and ensure claims are being addressed in a timely manner. - Oversee the daily operations of the coding department including workload, staffing, hiring, disciplining, performance appraisals, training, and monitoring of work. - Coordinate the planning and development of all policies and procedures pertaining to the programs to ensure compliance to all local, state, and federal regulations and to meet the goals of the program. - Interface with other internal departments as needed to ensure the smooth operation of all activities, such as MIS, account management, IT, etc. - Participate in presentations for prospective new clients. - Assists with the implementation of new clients. - Oversee and ensure timely completion of reviews to ensure contract compliance and regulatory time frames are being met. Qualifications: - Minimum of 10 years’ experience in inpatient coding and clinical validation in a payment integrity setting including both coding and clinical validation. - Certified Inpatient Coder or unrestricted registered nurse with CCS (Certified Coding Specialist) or - CIC (Certified Inpatient Coder). - Bachelor’s degree preferred. - Experience with ICD-10 coding. - Direct experience managing DRG coding teams within a large fast-growing payment integrity vendor is highly desirable. - Effective leadership skills. - Excellent writing and communication skills. - Excellent analytical skills - Must have knowledge of and the ability to identify ICD-10 CM/PCS code assignment, code sequencing, and discharge disposition, in accordance with CMS requirements, Official Guidelines for coding and reporting, and Coding Clinic guidance. - Must be fluent in application of current Official Guidelines and Coding Clinic Citations, in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments.

Position Summary: We are seeking a highly experienced DRG Clinical Physician Reviewer to join our growing clinical review team. This is a fully remote opportunity for a physician with a strong background in utilization review and clinical validation who thrives in a fast-paced, data-driven environment. In this role, you will review complex hospital cases to ensure accurate DRG assignment, validate clinical documentation, and support evidence-based determinations that directly impact healthcare quality and reimbursement integrity. Responsibilities: - Perform DRG Clinical Validation reviews to ensure diagnoses are accurate, supported, and compliant - Evaluate medical records, diagnostic findings, and treatment plans using evidence-based guidelines - Produce clear, concise clinical summaries and determinations within established turnaround times - Identify opportunities for improved documentation, coding accuracy, and cost containment - Conduct readmission and level of care reviews, including outlier and appeal cases - Collaborate with internal teams and, when needed, engage with providers to support clinical findings - Contribute to quality assurance initiatives and ongoing program development Qualifications: - MD/DO required with active, unrestricted U.S License - Board Certification required (ABMS or AOA) - 5+ years of clinical practice experience - REQUIRED: Strong utilization review experience (UM, DRG Validation, or clinical documentation review) - Experience with DRG Validation, CDI, or claims review strongly preferred - Proven ability to interpret complex clinical data and apply guidelines objectively - Strong written communication skills with the ability to clearly justify clinical decisions Why This Role Stands Out: - 100% remote – work from anywhere in the U.S - High-impact role influencing clinical accuracy and healthcare outcomes - Join a growing, mission-driven team at the intersection of clinical care and healthcare analytics - Consistent, structured workflow with meaningful case variety Compensation: 230K

Role Description 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. The Product Manager leads the creation of next-generation Payment Integrity (PI) products from concept to market launch. This role defines product strategy, identifies market opportunities, shapes new product concepts, and guides solutions from early ideation through development, implementation, and operational handoff. The Product Manager works at the intersection of healthcare, technology, and regulatory change to design products that help payers prevent improper payments, reduce administrative burden, and improve provider experience. This role is for a builder: someone who thrives in ambiguity, sees patterns in complexity, and can turn ideas into scalable, market-ready products. Responsibilities - Product Strategy & Market Discovery - Define the long‑term vision for new Payment Integrity products and capabilities. - Conduct market discovery to identify unmet payer needs, emerging regulatory opportunities, and competitive gaps. - Evaluate new product opportunities using market sizing, ROI modeling, and customer insights. - Translate strategic opportunities into clear product concepts and value propositions. - Product Definition & Concept Development - Own the end‑to‑end definition of new PI products, from early concept through MVP and full‑scale release. - Develop product narratives, user value stories, and solution frameworks that guide engineering and design. - Define the product’s core capabilities, differentiators, and success metrics. - Partner with clinical, regulatory, and actuarial experts to ensure product concepts align with CMS and commercial payer requirements. - Roadmap Ownership & Execution Leadership - Build and maintain a multi‑year roadmap that sequences product capabilities from MVP to maturity. - Prioritize features based on customer value, strategic impact, and technical feasibility. - Lead cross‑functional teams through product development cycles, ensuring alignment across engineering, data science, operations, and go‑to‑market teams. - Make tradeoff decisions that balance innovation, speed, and long‑term scalability. - Go‑to‑Market & Operational Handoff - Partner with implementation teams to define launch strategy, pricing, packaging, and positioning. - Prepare operational teams for product adoption, including training, documentation, and performance expectations. - Ensure a smooth transition from product build to operational ownership while maintaining product integrity and vision. - Monitor early performance and guide post-launch enhancements. - Product Performance & Evolution - Define and track KPIs such as financial impact, accuracy, provider abrasion, and automation rates. - Use customer feedback, market signals, and performance data to refine and expand product capabilities. - Anticipate regulatory and industry shifts and evolve the product roadmap accordingly. Qualifications - Bachelor’s degree in healthcare related field. - 4–8 years of experience in product management, preferably in healthcare, payment integrity, claims, or health tech. - Proven ability to take a product from concept → MVP → launch → operational scale. - Strong understanding of payer economics, claims processes, and PI market dynamics. - Experience building roadmaps, defining product strategy, and leading cross‑functional teams. - Ability to translate complex regulatory and clinical concepts into clear product direction. - Excellent communication skills, especially in articulating product vision and influencing stakeholders. Experience - Experience with reimbursement methodologies (DRG, HCC, PDPM, IRF CMG). - Background in healthcare technology, analytics, or clinical operations. - Prior experience launching new PI products or building PI capabilities from scratch. - Familiarity with payer procurement cycles and go‑to‑market strategies. Skills and Competencies - CMS policies and practices, including NCD’s and LCD’s, NCCI Edits for PTP and MUE, and APC groupers. - Strong analytical and problem-solving abilities. - Collaborative mindset and ability to work effectively across cross-functional teams. - Proficiency in Outlook, Word, Excel, and other applications. - Excellent written and verbal communication skills. - Maintain professional credentialed status with approved continuing education programs. - Ability to work independently and can multi-task or transition to different tasks easily.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are seeking a strategic and analytically driven Business Analyst to join our Product Development team within a fast-growing Payment Integrity organization. This role sits at the intersection of product strategy, data, technology, and healthcare/payment operations. Reporting directly to the VP of Product Development, you will partner closely with Product Managers, Engineering, Data Science, and Compliance teams to shape and deliver solutions that reduce waste, improve accuracy, and drive measurable value for customers. You will leverage advanced analytics and AI tools to generate insights, inform decision-making, evaluate product performance, and identify new market opportunities. This is a highly visible role with direct influence on product strategy, business cases, and go-to-market outcomes. Key Responsibilities - Product Strategy & Planning - Partner with Product Managers to define product vision, roadmap priorities, and feature requirements - Translate business needs into clear, actionable requirements, user stories, and success metrics - Develop and manage business cases, ROI models, and cost-benefit analyses for new initiatives - Analytics & Insights - Analyze product performance, customer usage, and operational data to identify trends and improvement opportunities - Design dashboards, KPIs, and reporting frameworks to measure product success - Leverage AI/ML tools and automation to accelerate analysis, forecasting, and decision support - Conduct market, competitive, and customer research to inform strategy - Cross-Functional Collaboration - Work closely with Engineering and Data teams to ensure requirements are feasible and delivered effectively - Support sprint planning, backlog refinement, and release readiness - Act as a liaison between technical and non-technical stakeholders - Market & Growth Opportunities - Identify new product opportunities, customer segments, and revenue streams - Evaluate industry trends, regulatory shifts, and emerging technologies - Recommend enhancements or new solutions aligned with payment integrity goals - Compliance & Risk - Provide regulatory and compliance input throughout the product lifecycle - Ensure solutions align with healthcare, payer, and payment integrity standards - Partner with legal/compliance teams to assess risks and mitigation strategies Qualifications - 3+ years of experience in Business Analysis, Product, Strategy, or related role - Experience in healthcare, payment integrity, claims, payer operations, or fintech strongly preferred - Strong analytical skills with experience working with large datasets and BI tools (SQL, Excel, Tableau/Power BI, etc.) - Familiarity with AI-enabled tools or advanced analytics platforms - Proven ability to build business cases and quantify product impact - Experience working in Agile product development environments - Strong communication skills with the ability to translate complex concepts for varied audiences - Ability to balance strategic thinking with execution - Experience with predictive modeling or data science collaboration - Knowledge of healthcare regulatory frameworks (CMS, HIPAA, etc.)

• Conduct thorough data audits to ensure accuracy in claims processing and resolution. • Analyze large datasets to identify patterns, discrepancies, and trends related to claims performance. • Work closely with team members to share insights, collaborate on problem-solving, and contribute to discussions regarding claims audits. • Resolve claims discrepancies by determining whether claims are underpaid or overpaid, providing clear documentation of findings. • Maintain high standards of accuracy and efficiency while following established leadership guidelines. • Prepare and present audit findings and recommendations to leadership in a clear and concise manner.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description MedReview is looking for a talented and experienced Data Scientist to join our dynamic team. As a part of our team, you will leverage your analytical skills and expertise in machine learning to extract insights from complex datasets and drive data-driven decision-making across our organization. You will collaborate closely with cross-functional teams to develop predictive models, uncover actionable insights, and solve challenging business problems. As part of a global team of developers and analysts, the Data Scientist will work with a larger team to design, build, validate, refine, and operationalize models. Responsibilities - Problem Identification: Collaborate with stakeholders to identify business challenges that can be solved through data analysis. - Data Collection & Preparation: Gather data from various sources (SQL databases, APIs, web scraping), then clean and "wrangle" it to ensure accuracy for modeling. - Model Development: Design and implement algorithms and predictive models using machine learning techniques to forecast outcomes or categorize information. - Exploratory Data Analysis (EDA): Analyze datasets to uncover hidden patterns, trends, and anomalies. - Communication & Visualization: Translate technical findings into "data stories" using tools like Tableau or Power BI to influence executive decisions. Qualifications - Master’s degree or bachelor's degree and equivalent experience in a quantitative field (Math, CS, Stats) - Proficiency in Python or R along with SQL for database querying. - Strong foundation in linear algebra, calculus, and statistical modeling. - Experience with frameworks like TensorFlow, PyTorch, or scikit-learn. - Critical thinking, curiosity, and the ability to explain complex concepts to non-technical audiences. - Experience working with global and remote teams.