Rheumatology Physician Specialist
5 days ago
This remote opportunity offers the flexibility to customize your schedule and caseload within the week while maintaining client-mandated turnaround times.
Candidates must hold an active Texas License and possess a strong understanding of national, state, and professional association guidelines and peer-reviewed literature.
Physician Specialties: Rheumatology
JOB SUMMARY
The physician reviewer will utilize clinical expertise to review insurance appeals, prospective, and retrospective claims. This role requires the 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:
- The physician reviewer will work as a contractor with Dane Street, reviewing all medical records and addressing each question posed by the client utilizing client-specific criteria or other nationally recognized evidence-based criteria.
- A flat rate is offered for Group Health Record/Policy Reviews.
- The reviewer will ensure that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision.
- Current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature will be utilized to support sound and objective decision-making and rationales in reviews.
- Copies of any criteria utilized in a review will be provided with the report promptly.
- Makes telephone calls as mandated by the state and/or client specifics.
- Peer to Peer calls may be required. Dane Street will help arrange any Peer to Peer phone calls, if needed.
- The average length of time to review each case is between 15-30 minutes.
- Cases are prepared before they are provided for review.
- Sometimes cases require a short turnaround time, meaning they need to be reviewed the same day.
- Returns cases on or before the due date and time.
- 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: In the interest of security for both parties, please note that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.
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