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    • Experience with medical chart reviews (minimum 1–2 years preferred).
    • Review patient medical charts for completeness, accuracy, and compliance with CMS Risk…
    • View all Premier Health jobs - Work from Home jobs
    • Salary Search: MRA Chart Reviewer salaries
    • Submit medical claims accurately and efficiently to insurance payers.
    • Insurance claims follow-up and denials management.
    • Knowledgeable in EOB interpretation and claims processing.
    • Manage Accounts Receivable (AR) and follow up on unpaid or denied claims.
    • Strong understanding of medical billing workflows, claim submission, and coding fundamentals.
    • Review claims prior to submission to identify coding, demographic,…
    • 2+ years of experience working closely with US healthcare claims or in a claims processing/adjudication environment.
    • Work Setup: In‑Office Training Required.
    • Work denied exam and evaluation claims, including modifier and medical necessity issues.
    • The specialist will work the practice’s unpaid and denied claims:…
    • Medicare and Medi-Cal claims processing.
    • Familiarity with payer platforms and claims adjudication systems.
    • Strong understanding of CPT, HCPCS, and ICD-10-CM/PCS…
    • 4 years experience in medical billing, coding, claims processing, bill and/or chart review/auditing required.
    • Provide written and oral presentations to Medical…
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    • We’re looking for a Remote Medical Billing Specialist who is detail-oriented, dependable, and confident managing Medicaid billing and claims from submission…
    • Submit and manage medical claims through Office Ally and similar programs.
    • 2+ years of U.S. medical billing experience.
    • CPT, ICD-10, and HCPCS coding.
    • Experience in U.S. medical billing, medical coding, claims processing, or Revenue Cycle Management (RCM).
    • Prepare, review, and submit accurate medical claims to…
    • Knowledgeable in EOB interpretation and claims processing.
    • Manage Accounts Receivable (AR) and follow up on unpaid or denied claims.
    • Identify and correct medical billing errors.
    • Ability to explain EOBs, claims, and denials effectively.
    • Strong understanding of claims processing for providers (…
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    • Ustomer Service in medical claims/billing in US Healthcare: 1 year (Required).
    • Demonstrate basic working knowledge of healthcare claims processing.
    • Experienced on medical billing/ AR Collections.
    • Ability to identify and correct medical billing errors.
    • Ability to analyze, identify and trend claims issues to…

Job Post Details

MRA Chart Reviewer
Premier Health
·
2.6
Remote
Full-time
Apply now

Job details

Pay information not provided
Full-time
Remote

Full job description

Job Title: Risk Adjustment Chart Reviewer

Department: Revenue Cycle / Quality & Compliance
Location: Remote
Reports To: MRA Manager / Coding Manager

Job Summary

The Medicare Risk Adjust (MRA) Chart Reviewer is responsible for reviewing medical records to identify and validate accurate diagnoses in support of MRA and HCC coding. This role ensures documentation of diagnoses supports all reported conditions and complies with CMS and ICD-10-CM guidelines.

Key Responsibilities

  • Review patient medical charts for completeness, accuracy, and compliance with CMS Risk Adjustment guidelines
  • Identify and validate HCC (Hierarchical Condition Category) diagnoses
  • Ensure all chronic and acute conditions are properly documented and coded
  • Perform prospective and retrospective chart reviews to identify and validate diagnoses, and to assess documentation
  • Identify documentation gaps and provide feedback to providers
  • Collaborate with providers to clarify documentation when needed
  • Maintain productivity and quality standards
  • Follow ICD-10-CM, CMS, and internal coding policies
  • Support audit preparation and compliance initiatives

Qualifications

  • Medical knowledge (MD, or other equivalent medical/clinical credentials/experiences preferred)
  • Knowledge of ICD-10-CM and CMS Risk Adjustment (HCC) coding (CRC, CDIP, or equivalent preferred)
  • Experience with medical chart reviews (minimum 1–2 years preferred)
  • Familiarity with EHR systems (eCW, Epic, Athena, etc.)
  • Strong attention to detail and analytical skills
  • Ability to work independently and meet productivity targets

Preferred Skills

  • Experience with Medicare Advantage and value-based care programs
  • Knowledge of RAF score methodology
  • Understanding of CMS audit processes (RADV, OIG)
  • Excellent written and verbal communication skills

Performance Metrics

  • Chart review productivity targets
  • Coding accuracy and audit pass rate
  • Turnaround time
  • Provider query resolution rate

Work Schedule

Full-time / Part-time (as applicable)
Monday – Friday

Job Type: Full-time

Work Location: Remote

Job Type: Full-time

Work Location: Remote

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