Medical Review

Company Description Imperium Resolutions is a specialized advisory practice focused on healthcare audit defense, claim denial resolution, and compliance strategy, led by professionals with extensive experience inside Medicare contractor organizations such as ZPIC/UPIC, RAC, and MAC. The organization applies deep institutional knowledge of how audits are designed, how medical review guidelines are developed, and how determinations are made to support healthcare providers, organizations, and legal counsel facing complex audit and payment disputes. Engagements are accepted selectively to ensure a high level of focus, confidentiality, and tailored strategy. Services span Medicare and commercial payer audit defense, claim denial review and resolution, appeal strategy, extrapolated overpayment assessment, and pre- and post-bill claim review. Imperium Resolutions differentiates itself by understanding how auditors think and using that insight to build strong, defensible responses for its clients.

Role Description The Medical Review role is a remote, contract position responsible for performing detailed clinical reviews of healthcare claims and documentation. Day-to-day tasks include evaluating medical records for coverage, necessity, coding accuracy, and compliance with payer and regulatory requirements, as well as identifying documentation gaps and potential risk areas. The role involves summarizing medical findings, preparing clear review reports, supporting appeal strategies, and contributing to audit defense and denial resolution efforts. The Medical Reviewer will collaborate with internal consultants, legal teams, and client staff to clarify clinical issues, interpret payer policies, and provide evidence-based recommendations. This position requires consistent, timely review work, adherence to internal quality standards, and the ability to manage a remote workload with minimal supervision.

Qualifications

• Clinical expertise and licensure: Active clinical credential such as RN, PA, NP, or equivalent, with strong experience in patient care and chart review.
• Medical record and coding review skills: Proficiency in interpreting clinical documentation, applying ICD-10, CPT/HCPCS, and modifiers, and assessing medical necessity and coverage criteria.
• Audit, compliance, and payer policy knowledge: Experience with Medicare and commercial payer rules, audit processes (e.g., RAC, UPIC, MAC), and healthcare compliance standards.
• Analytical and writing skills: Ability to synthesize complex clinical and regulatory information, write concise review summaries, and prepare clear, defensible rationales for approvals or denials.
• Technology and remote work skills: Competence with electronic health records, secure file-sharing platforms, spreadsheets, and report templates, along with reliable remote work practices.
• Communication and collaboration abilities: Strong written and verbal communication skills, experience collaborating with multidisciplinary teams, and comfort discussing findings with clinicians, consultants, and legal partnerso