Physician Reviewer for Insurance Appeals

4 weeks ago


Bellevue, Washington, United States Dane Street Full time

This opportunity offers the flexibility to customize your schedule and caseload within the week while maintaining client-mandated turnaround times. As a 1099 independent contractor, you will be compensated on a per-case basis.

Preferred candidates will hold a WA license and be certified, or willing to become certified, with the Washington State Department of Labor and Industries (L&I).

Highlights:

  • In-person Exams to be conducted in Bellevue, WA, with additional locations to be added in the future
  • Multiple exams over the course of a day
  • Dane Street will pay for reasonable travel expenses
  • Dane Street will assist you in obtaining WA L&I certification
  • Video recording of approximately 15% of exams may be needed

Job Summary:

As a Physician Reviewer, you will utilize your clinical expertise to review insurance appeals, prospective and retrospective claims. You 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 in a timely manner
  • 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

Please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.



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