Diagnosis Validation Reviewer

The ideal candidate is a clinically knowledgeable, detail-oriented non-practicing physician with strong clinical judgment, chart review experience, and the ability to evaluate complex medical records for documentation support of diagnoses. They can translate medical record findings into clear, concise clinical comments and are comfortable balancing quality, accuracy, and productivity in a structured remote review environment. Candidates with experience in clinical documentation review, coding , CDI , risk adjustment, HCCs, outpatient review, or diagnosis validation are especially well suited for this role. The strongest candidates will be self-directed, adaptable, quick to learn new workflows, and comfortable using training materials, clinical resources, and independent research to accurately assess unfamiliar conditions.

Requirements

• Physician background (foreign-trained or U.S.-trained accepted)
• Strong clinical knowledge
• Excellent written and verbal communication skills
• Experience with Risk Adjustment
• Experience with HCC methodologies
• Knowledge of medical terminology
• Experience reviewing clinical documentation
• Ability to work independently

Preferred Qualifications

• Outpatient clinical experience
• CDI experience
• ECFMG Certification
• Risk Adjustment experience
• Chart review experience
• Diagnosis validation experience
• Population Health experience