Browse
Employers / Recruiters

Physician Reviewer - (Ophthalmology, Otolaryngology, OB/GYN)

dane-street-llc · 30+ days ago
Negotiable
Full-time
Remote
Continue
By pressing the button above, you agree to our Terms and Privacy Policy, and agree to receive email job alerts. You can unsubscribe anytime.

This telework opportunity provides the ability to customize your schedule and caseload within the week while maintaining client-mandated turnaround times. Our reviewers are compensated on a per-case basis as a 1099 independent contractor.

Preferred candidates will hold a NM, TX, MN, and/or NC License.

Physician Specialties:  Radiation Oncology, Cardiology, Rheumatology, Ophthalmology, Otolaryngology, OB/GYN, Hematology/Oncology 

JOB SUMMARY

Utilizes clinical expertise and reviews insurance appeals, as well as prospective and retrospective claims. The physician reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.

MAJOR DUTIES AND 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 prior to the due time of the case
  • Returns cases on or before the due date and time
  • Makes telephone calls as mandated by the state and/or client specifics
  • Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
  • Attends all required orientation and training
  • Performs other duties as assigned, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits

NOTICE: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.

Last updated on Mar 20, 2024

See more

About the company

More jobs at dane-street-llc

Analyzing

Charleston, South Carolina

 · 

30+ days ago

Remote

 · 

30+ days ago

Remote

 · 

30+ days ago

Remote

 · 

30+ days ago

Developed by Blake and Linh in the US and Vietnam.
We're interested in hearing what you like and don't like! Live chat with our founder or join our Discord
Changelog
🚀 LaunchpadNov 27
Create a site and sell services based on your resume.
🔥 Job search dashboardNov 13
Revamped job search UI with a sortable grid, live filtering, bookmarks, and application tracking.
🫡 Cover letter instructionsSep 27
New Studio settings give you control over AI output.
✨ Cover Letter StudioAug 9
Automatically generate cover letters for any job.
🎯 Suggested filtersAug 6
Copilot suggests additional filters above the results.
⚡️ Quick applicationsAug 2
Apply to jobs using info from your resume. Initial coverage of ~200k jobs in Spain, Germany, Austria, Switzerland, France, and the Netherlands.
🧠 Job AnalysisJul 12
Have Copilot read job descriptions and extract out key info you want to know. Click "Analyze All" to try it out. Click on the Copilot's gear icon to customize the prompt.
© 2024 RemoteAmbitionAffiliate · Privacy · Terms · Sitemap · Status