SUPERVISING MEDICAL REVIEW ANALYST
Supervising Medical Review Analyst is a state title in New Jersey's competitive civil service, which means the way in is an open exam rather than a direct appointment.
On paper it calls for a master's degree, though the specification lets enough relevant experience stand in for the degree. Pay on the FY2027 schedule runs $95,955 to $141,386, and state payroll currently lists 8 people in the title, most of them at Office of State Comptroller.
How to apply
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Exam
This is an application to sit an exam and be placed on an eligible list for this title, not an application for a specific job. A $35 application fee applies to Non-Public-Safety announcements issued on or after 2026-02-01. There may be no current vacancy behind it, and the list it produces may not be certified for months or years.
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Exam
Open to permanent employees in the competitive division who hold a qualifying lower title in the same unit. A $35 application fee applies to Non-Public-Safety announcements issued on or after 2026-02-01. Like the open competitive exam, this places you on a list; it is not itself a job offer.
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Agency posting
Office of the State Comptroller's employment page may require a click-through to see specific openings. Provisional appointment against a posted vacancy is how most people are actually hired into this kind of title.
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Agency posting
Department of Human Services's employment page may require a click-through to see specific openings. Provisional appointment against a posted vacancy is how most people are actually hired into this kind of title.
Who employs this title
State payroll records show 8 people working under this title. The median actual salary is $134,410. The agencies employing the most are:
- Office of State Comptroller (5)
- Human Services (3)
Counts from NJ YourMoney agency payroll. See statewide workforce analytics.
Official job specification
The text below is the official specification published by the New Jersey Civil Service Commission. The plain-language summary and analysis above are derived from it by NJ Civil Service Navigator.
Definition
Under the direction of a supervisory officer, plans and coordinates activities and supervises staff involved in the review, analysis and evaluation of provider services; provider and client utilization practices; the audit and recovery of inappropriately paid or other available monies; does related work
Examples of work
Develops and implements methods to identify and recover program funds. Develops requirements for handling claims involving third party liability, probate, voluntary repayment, Tort and other insurance coverage and resources, invalid or fraudulent claims, or other claims involving payment for diagnostic laboratory services. Plans, and supervises the office and fields activities of Medical Review Analysis, and other personnel. Coordinates activities with other department units and outside agencies. Prepares and supervises the preparation of reports containing findings, conclusions and recommendations. Participates in conferences concerning recovery activities. Prepares correspondence. Maintains case files. Reviews and evaluates pending legislation. Reviews current case law decisions in the New Jersey Law Journal and analyzes their effect on recovery efforts. Reviews and assigns cases referred to the Unit from other department units and jurisdictions, to recover inappropriately paid monies. Supervises the initiation of suspension, and disqualification proceedings against aberrant providers. Plans, supervises, and coordinates the activities of professional and clerical staff effecting actions for Program exclusions and recovery of overpayments including interest, treble damages and false claims. May develop and implement case review methods, identification of overpayments and penalty assessments. Testifies at hearing before the Office of Administrative Law, and Civil and criminal court proceedings when required. Consults with state auditors to discuss provider liabilities for case resolution; consults with other officials for fraud and abuse; coordinates inter-state recoveries and provider exclusions. Plans for and supervises valid cost avoidance studies. Identifies methods to address client and fraud abuse; develops and expands a progressive system of client surveillance. Develops and implements surveillance systems to supervise, evaluate and control the activities of service providers. Supervises staff utilizing computer systems to monitor clients and health care providers. Supervises staff involved in the review and billing of medical record keeping practices of providers. Establishes and maintains cooperative working relationships with other state, local and private agencies. Identifies cases of suspected provider and client abuse of benefits; assigns cases for audit. Supervises staff responsible for the preparation of potential fraud and abuse cases. Plans, coordinates and implements methods to monitor program areas affected by legislative changes to the New Jersey Medicaid, PAAD, and/or Lifeline statutes. Develops and implements methods to evaluate the claims processing and payment systems to ensure that payments to health service providers are submitted according to established fee schedules and regulations. Develops and implements complaint and other information reporting procedures. Reviews and evaluates staff performance. Supervises the establishment and maintenance of essential records, files and reports. Will be required to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.
License
Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform the essential duties of the position.
Knowledge, skills and abilities
Knowledge of the methods used to audit medical claims and identify cases of suspected abuse and fraud. Knowledge of medical record keeping and billing practices. Knowledge of medical and legal terminology. Knowledge of interviewing techniques. Ability to read, interpret and apply laws, rules, and regulations. Ability to coordinate and supervise staff activities involved in the review, analysis and evaluation of provider services, and provider and client utilization practices. Ability to develop and implement methods to recover funds. Ability to coordinate unit activities with those of other units. Ability to provide testimony in court. Ability to provide assignments and instruction to staff and supervise their work performance. Ability to establish and maintain cooperative working relationships with other state, local and private agencies. Ability to identify suspected cases of fraud and abuse. Ability to prepare correspondence. Ability to prepare and supervise the preparation of reports containing findings, conclusions and recommendations. Ability to establish and maintain records and files. Ability to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units. Ability to read, write, speak, understand, and communicate in English sufficiently to perform duties of this position. American Sign Language or Braille may also be considered as acceptable forms of communication. Persons with mental or physical disabilities are eligible as long as they can perform essential functions of the job with or without reasonable accommodation. If the accommodation cannot be made because it would cause the employer undue hardship, such persons may not be eligible.
Note
The examples of work for this title are for illustrative purposes only. A particular position using this title may not perform all duties listed in this job specification. Conversely, all duties performed on the job may not be listed. Applicants must meet one of the following or a combination of both experience and education. Thirty (30) semester hour credits are equal to one (1) year of relevant experience. Nine (9) years of professional experience with a large private or public health agency in work involving the review, analysis, investigation, authorization, and/or payment of medical or health care services, two (2) years of which shall have been in a supervisory or consultative capacity. OR Possession of a bachelor's degree from an accredited college or university; and five (5) years of the above-mentioned professional experience, two (2) years of which shall have been in a supervisory or consultative capacity. OR Possession of a Master's degree from an accredited college or university in Health Administration, Hospital Administration, Public Administration, or Business Administration; and four (4) years of the above-mentioned professional experience, two (2) years of which shall have been in a supervisory or consultative capacity. "Professional experience" refers to work that is creative, analytical, evaluative, and interpretive; requires a range and depth of specialized knowledge of the profession's principles, concepts, theories, and practices; and is performed with the authority to act according to one's own judgment and make accurate and informed decisions.
Study guides for this exam
- Supervisory Test Battery (STB) National Learning Corporation · $56.99
- General Supervisor National Learning Corporation · $49.90 · general prep, not specific to this title
The Civil Service Commission does not publish official study guides or release past tests. These are independent equivalency guides.