Chart Clinical Reviewer
Remote Full-time Healthcare & Life Sciences Senior
Job Title: Prospective Chart Reviewer
Location: Not Specified
Commitment: Full-Time
Industry: Healthcare & Life Sciences
Seniority Level: Senior
Overview
We are seeking an experienced Prospective Chart Reviewer to conduct pre-visit medical record reviews and identify clinical alerts that may support underlying diagnoses. This role plays a critical part in enabling providers to address chronic conditions during patient encounters by presenting concise, evidence-based clinical insights through point-of-care tools. The ideal candidate will have strong clinical expertise, relevant chart review experience, and prior experience leading a team of chart reviewers.
Key Responsibilities
- Perform pre-visit medical record reviews to identify chronic conditions documented in prior years.
- Review patient records to identify diagnoses that lack sufficient supporting documentation.
- Identify and prioritize clinical alerts that indicate potential underlying chronic conditions.
- Present clinical findings to providers in a concise, accurate, and actionable manner through point-of-care tools.
- Lead and support a team of chart reviewers, leveraging at least 2 years of team handling experience.
- Ensure high-quality, accurate, and timely chart reviews while meeting productivity standards.
- Adhere to organizational policies, procedures, and quality standards.
- Deliver excellent customer service by responding effectively to the needs of internal and external stakeholders.
- Take ownership of professional development by continuously enhancing clinical knowledge and skills.
- Communicate effectively with internal and external stakeholders in a professional manner.
- Demonstrate attention to detail and maintain high standards of accuracy in all work.
- Complete additional responsibilities as assigned.
Required Qualifications
- Medical Doctor (MD) degree.
- Minimum 2 years of clinical experience.
- Minimum 2 years of experience managing or leading a team of chart reviewers.
- Relevant experience in prospective or retrospective medical chart review.
- Advanced clinical knowledge of chronic disease states.
- Strong understanding of clinical documentation and diagnosis validation.
- Excellent written and verbal communication skills.
- Strong analytical and problem-solving abilities.
- Ability to apply logical and scientific reasoning to clinical scenarios.
- Proficiency with Microsoft Office, including Word, Excel, Outlook, and PowerPoint.
- Strong attention to detail with the ability to maintain high levels of accuracy and productivity.
Preferred Qualifications
- Coding certification through AHIMA or AAPC.
- Experience working with clinical documentation improvement (CDI), risk adjustment, or value-based care programs.
- Familiarity with healthcare quality and compliance standards.