Remote Board Certified Physician Reviewer
Dane Street
πRemote - United States
Please let Dane Street know you found this job on JobsCollider. Thanks! π
Job highlights
Summary
The job is for a teleworking Gastroenterology physician who will review insurance appeals and claims as an independent contractor. The physician must hold an active NM License and provide interpretations of medical necessity in compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.
Requirements
- Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
- Attends all required orientation and training
Responsibilities
- Reviews all medical records and addresses each question posed by the client utilizing client-specific criteria or other nationally recognized evidence-based criteria
- Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision
- Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes
- Provides copies of any criteria utilized in a review with the report on time
- Returns cases on or before the due date and time
- Makes telephone calls as mandated by the state and/or client specifics
Preferred Qualifications
Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits
Benefits
Compensated on a per-case basis
Share this job:
Disclaimer: Please check that the job is real before you apply. Applying might take you to another website that we don't own. Please be aware that any actions taken during the application process are solely your responsibility, and we bear no responsibility for any outcomes.
Similar Remote Jobs
- πUnited States
- πUnited States
- πUnited States
- πUnited States
- πUnited States
- πUnited States
- πUnited States
- πUnited States
- πUnited States
Please let Dane Street know you found this job on JobsCollider. Thanks! π