Endocrinology Physician

Dane Street; Texas; Remote; USD 150,000 - 200,000; Full time

Job summary

A leading company is seeking an Endocrinology Physician to perform clinical reviews of insurance appeals and medical claims. This telework role offers flexibility while ensuring compliance with medical standards. Candidates must have an active Texas medical license.

Qualifications

• Must hold an active Texas License.
• Utilizes clinical expertise to review insurance appeals.

Responsibilities

• Performs clinical reviews of insurance appeals and medical claims.
• Ensures compliance with medical standards and client policies.
• Maintains proper credentialing and state licenses.

Skills

Clinical Expertise

Healthcare Compliance

Evidence-Based Guidelines

Education

Active Texas Medical License

Job description

Endocrinology Physician at Dane Street summary :

The Endocrinology Physician performs clinical reviews of insurance appeals and medical claims, ensuring compliance with medical standards and client policies. This role requires an active Texas medical license and the ability to provide objective evaluations based on nationally recognized guidelines. The physician reviewer works as a 1099 independent contractor, with the flexibility to manage their schedule while adhering to strict turnaround requirements for case reviews.

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.

Candidates must hold an active Texas License.

JOB SUMMARY

Utilizes clinical expertise, reviews insurance appeals, and 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 :

• All of our physician reviewers are contractors with Dane Street.
• A flat rate is offered for Group Health Record / Policy Reviews.
• 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 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.
• The cases are prepared for you before they are provided for your review.
• Some cases may REQUIRE a short turnaround time meaning some cases may 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 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.

Keywords :

Endocrinology, Physician Reviewer, Telehealth, Medical Claims Review, Clinical Expertise, Insurance Appeals, Texas Medical License, Evidence-Based Guidelines, Healthcare Compliance, Independent Contractor

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Endocrinology Physician • Not Specified, TX, USA