Medical Reviewer: Job Description, Duties and Requirements

Sep 15, 2019

Medical reviewers require a small amount of formal education. Learn about the education, job duties and optional certification to see if this is the right career for you.

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Medical reviewers examine medical documents for accuracy, such as looking at patient records and insurance paperwork. They can work in medical facilities or for independent firms. Completing a health information-related degree program is necessary, and certification is offered.

Essential Information

Medical reviewers perform audits on all medical records contained in health care facilities. Also known as medical auditors, they review data to ensure the accuracy of the record as well as assess the quality of patient care. Medical reviewers must complete at least a associate's degree through a technical school or community college. These professionals may also wish to obtain a Certified Professional Medical Auditor credential.

Required Education Associate's degree in health information or related field
Other Requirements Optional Certified Professional Medical Auditor certification
Projected Job Growth (2018-2028)* 11% for medical records and health information technicians
Median Annual Salary (2018)* $20,600 for medical records and health information technicians

Source: *U.S. Bureau of Labor Statistics

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 five-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.

Salary Info and Job Outlook

According to the U.S. Bureau of Labor Statistics (BLS, www.bls.gov), the employment of medical records and health information technicians, including medical reviewers, is expected to grow much faster than the national average through 2028. In May 2018, the BLS reported that workers in the 90th percentile or higher earned $66,260 or more per year, whereas the bottom 10th percentile earned $26,550 or less per year.

A medical reviewer performs an auditing service for medical institutions, checking various medical data for errors, validity, and completion. To become one, an associate's degree in health information or a similar field is usually needed. Professional certification is available, which entails passing an exam.

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