Gastroenterology Physician

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

Job summary

A leading healthcare company seeks a Gastroenterology Physician to review insurance appeals and medical services. This telework position offers a customizable schedule as an independent contractor, fulfilling critical compliance and documentation duties while holding an active Texas License.

Qualifications

• Candidates must hold an active Texas License.
• Requires expertise in Gastroenterology and insurance appeals.

Responsibilities

• Review insurance appeals and medical necessity for services.
• Document determinations and maintain compliance standards.
• Conduct peer to peer calls if required.

Skills

Clinical Expertise

Healthcare Compliance

Peer Review

Education

Active Texas License

Job description

Gastroenterology Physician at Dane Street summary :

The Gastroenterology Physician role involves reviewing insurance appeals and medical necessity for healthcare services while adhering to client policies and national guidelines. This telework position allows for a customizable schedule and requires candidates to have an active Texas License. Responsibilities include detailed reviews of medical records, documenting determinations, and maintaining proper credentialing and compliance standards.

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.

Physician Specialties : Gastroenterology

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 :

Gastroenterology, Insurance Appeals, Medical Necessity, Healthcare Review, Telework Physician, Independent Contractor, Clinical Expertise, Texas License, Healthcare Compliance, Peer Review

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Gastroenterology Physician • Not Specified, TX, USA