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A medical review specialist is a unique role where nurses help to ensure that health care services are delivered in a manner that balances high-quality, efficient care that is also fairly priced and compliant. Nurses in this role will review patient charts, billing, and documentation to ensure a variety of different things important to health care organizations.

In order to be competent in this role, a different set of skills will be crucial for success and can be a great option, especially in certain states and areas. Let’s discuss three important skills that are paramount for the medical review specialist role.

1. Workload management

A medical review specialist will have numerous tasks and projects they are working on at one time. In this role, you could expect to be working with numerous different individuals and multiple different deadlines. Given these realities, the ability to stay organized and manage workload will be of vital importance. The ability to manage a significant amount of work at the same time will be a daily task that you must be proficient in to succeed in the role.

2. Attention to detail

In this role, a period in the wrong place or a missing sentence could mean the organization doesn’t get reimbursed for the care they provided. A medical review specialist will be expected to review doctor’s notes, coding, billing, and other data within a patient’s chart. This requires a strong attention to detail because seemingly insignificant things can cause serious consequences. Without this skill, you will struggle to be effective in this role.

3. In-depth understanding of coding and regulations

Medical review specialists must think in a way that is unusual for most nurses. While bedside nurses tend to have a broad focus on the care of the patient, a medical review specialist is focused on small but significant behind-the-scenes factors such as coding and regulations. This role requires a new set of knowledge not needed by other nursing roles. In essence, a medical review specialist completes the work for the care given by other nurses, doctors, and practitioners by ensuring the charting was proper and accurately encapsulates all the care given. If elements are missing, individuals in this role will reach out to members of the care team to have them correct their charting.

To be successful as a medical review specialist, one must be competent in workload management, pay attention to the details, and have in-depth knowledge of coding and other regulations.

Tyler Faust, MSN, RN
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