Physician Reviewer - Medical Appeals

Location Type: Remote Employment Type: 1099 Independent Contractor

Position Overview

This telework opportunity offers flexibility in customizing your schedule and caseload while adhering to client-mandated turnaround times. Physician reviewers are compensated on a per-case basis.

Physician Specialties

• Radiation Oncology
• Cardiology
• Rheumatology
• Ophthalmology
• Otolaryngology
• OB/GYN
• Hematology/Oncology

Preferred Licenses

Preferred candidates will hold a license in one or more of the following states:

• New Mexico (NM)
• Texas (TX)
• Minnesota (MN)
• North Carolina (NC)

Job Summary

Utilizes clinical expertise to review insurance appeals, prospective, and retrospective claims. The physician reviewer provides an interpretation of the medical necessity of services rendered by other healthcare professionals, ensuring compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.

Major Duties and Responsibilities

• Reviews all medical records and addresses client-posed questions using client-specific criteria or other nationally recognized evidence-based criteria.
• Ensures the rationale for determinations is clear, concise, and adequately supported by documentation.
• Identifies, critiques, and utilizes current criteria and resources (e.g., national, state, and professional association guidelines, peer-reviewed literature) for sound and objective decision-making.
• Provides copies of any criteria utilized in a review with the report before the due time.
• Returns cases on or before the specified due date and time.
• Makes telephone calls as mandated by state and/or client specifics.
• Maintains proper credentialing, state licenses, and any necessary special certifications or requirements.
• Attends all required orientation and training sessions.
• Performs other duties as assigned, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.

Application Instructions

• Notice: In the interest of security, Dane Street will never conduct interviews via text or request checks from candidates for purchasing equipment.

Company Information

• Workplace: Remote
• Language: English
• Published: 2024-03-20