Physician Reviewer - (Ophthalmology, Otolaryngology, OB/GYN) Job at Dane Street, LLC, Charlotte, NC

bE95eEkvV29rYUpHUHd6VUVJK2srdjFzeHc9PQ==
  • Dane Street, LLC
  • Charlotte, NC

Job Description

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. #J-18808-Ljbffr Dane Street, LLC

Job Tags

For contractors,

Similar Jobs

Gentle Dental

Registered Dental Hygienist Job at Gentle Dental

$10,000 Signing Bonus $60 - $68 per hour plus an uncapped bonus plan At Gentle Dental, we value our teammates smile as much as our patients smile. Our vision is to provide exceptional, lifelong, integrated oral healthcare services. We enhance the quality of our... 

Apex Staffing, Inc.

Business Broker Job at Apex Staffing, Inc.

Growing locally owned business brokerage is seeking dynamic and professional Business Brokers to join their team! Great opportunity for someone looking for the flexibility of managing their own business, with the training and backing of an amazing team. This commission-... 

Crawford Thomas Recruiting

Chinese Nephrology Nurse Practitioner/Physician Assistant Job at Crawford Thomas Recruiting

Job Description Bilingual Physician Assistant (PA) or Nurse Practitioner (NP) (Mandarin or Cantonese) Our client is a well-established nephrology practice in Brooklyn, specializing in kidney disease management and internal medicine. Salary: $150k-$200k+ (based...

University Health

Healthcare Ethics Consultant (HONDO) Job at University Health

 ...of Ethics Services, provides expertise and effective clinical consultation to improve patient care. Provides ethics knowledge, analysis...  ...bioethics with two years of consultation experience. Must be Healthcare Ethics Consultation Certified (HEC-C). Experience in providing... 

FirstFleet Inc

CDL A Team Truck Drivers-Dedicated Job at FirstFleet Inc

 ...Job Description FirstFleet is a national dedicated carrier with 2600+ trucks. Our CLEVELAND, TN location is looking for ESTABLISHED TEAMS BE...  ...customer supermarket chain. $5000.00 sign on bonus - each driver NEW PAY PACKAGE!! Regular Team @ $..76 / Split...