Dermatology Physician

Dane Street; Alaska; Remote; USD 80,000 - 120,000; Full time

Job summary

An innovative firm offers a telework opportunity for a Dermatology Physician Reviewer. In this role, you will leverage your clinical expertise to review insurance appeals and claims, ensuring compliance with client policies and evidence-based guidelines. You will enjoy a flexible schedule while maintaining client-mandated turnaround times. This position allows you to work independently as a contractor, reviewing cases efficiently and ensuring that all determinations are well-documented and justified. If you are passionate about healthcare and want to make a significant impact, this opportunity is perfect for you.

Qualifications

• Must maintain proper credentials, licenses, and certifications necessary for the role.
• Experience in reviewing medical records and addressing client-specific questions.

Responsibilities

• Review insurance appeals and claims for medical necessity.
• Ensure compliance with client-specific policies and standards of care.
• Provide clear rationale for determinations supported by documentation.

Skills

Clinical Expertise

Medical Necessity Review

Evidence-Based Guidelines

Documentation Skills

Education

Medical Degree

Board Certification in Dermatology

Job description

This telework opportunity allows you 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.

Physician Specialty: Dermatology

JOB SUMMARY

Utilizes clinical expertise to review insurance appeals, and prospective and retrospective claims. The physician reviewer provides an interpretation of the medical necessity of services provided by healthcare professionals, ensuring compliance with client-specific policies, evidence-based guidelines, and standards of care.

MAJOR DUTIES AND RESPONSIBILITIES:

1. All physician reviewers are contractors with Dane Street.
2. A flat rate is offered for Group Health Record/Policy Reviews.
3. Review all medical records and address each question posed by the client using client-specific or nationally recognized evidence-based criteria.
4. Ensure the rationale for determinations is clear, concise, and supported by adequate documentation.
5. Utilize current criteria and resources such as national, state, professional guidelines, and peer-reviewed literature; avoid using limited sample size case studies.
6. Provide copies of criteria used during reviews promptly.
7. Make mandated telephone calls as required by the state or client specifics.
8. Peer-to-peer calls may be required; Dane Street will assist in arranging these.
9. The average review time per case is 15-30 minutes.
10. Cases are prepared in advance for review.
11. Some cases may require same-day review due to short turnaround times.
12. Return cases on or before the due date and time.
13. Maintain proper credentials, licenses, and certifications necessary for the role.
14. Attend all required orientation and training sessions.
15. Perform additional duties as assigned, including addressing quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits.

PLEASE BE AWARE: Dane Street will never conduct interviews via text or request checks for equipment purchases, ensuring the security of both parties.