Genetics Physician

Dane Street; Tampa (FL); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player offers a unique telework opportunity for a Clinical/Medical Geneticist. This role allows for flexible scheduling while ensuring compliance with client-specific policies and nationally recognized guidelines. As a physician reviewer, you will utilize your clinical expertise to assess insurance appeals and claims, ensuring that each determination is well-documented and supported by adequate evidence. Join a forward-thinking company that values your skills and provides a platform for impactful decision-making in healthcare.

Qualifications

• Must maintain proper credentialing, licenses, and certifications.
• Utilize current criteria and resources for objective decision-making.

Responsibilities

• Review insurance appeals and claims for medical necessity.
• Ensure compliance with client-specific policies and standards of care.
• Return cases on or before the due date and time.

Skills

Clinical Expertise

Medical Necessity Interpretation

Documentation Skills

Evidence-Based Guidelines Knowledge

Education

Medical Degree

Board Certification in Medical Genetics

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 Specialties: Clinical/Medical Geneticist

JOB SUMMARY

Utilizes clinical expertise to review insurance appeals and both 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, nationally recognized evidence-based guidelines, and standards of care.

MAJOR DUTIES AND RESPONSIBILITIES:

• All physician reviewers are contractors with Dane Street.
• A flat rate is offered for Group Health Record/Policy Reviews.
• Review all medical records and address each question posed by the client using client-specific criteria or other nationally recognized evidence-based criteria.
• Ensure that the rationale for each determination is clear, concise, and supported by adequate documentation.
• Utilize current criteria and resources such as national, state, and professional guidelines, as well as peer-reviewed literature, to support objective decision-making. Avoid reliance on case studies or cohorts with limited sample sizes.
• Provide copies of any criteria used in the review promptly.
• Make mandated telephone calls as required by the state or client specifics.
• Peer-to-peer calls may be necessary; Dane Street will assist in arranging these if needed.
• The average review time per case is between 15-30 minutes.
• Cases are prepared beforehand for review.
• Some cases may require same-day review due to short turnaround times.
• Return cases on or before the due date and time.
• Maintain proper credentialing, licenses, and certifications necessary for the role.
• Attend all required orientation and training sessions.
• Perform additional duties as assigned, including addressing quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits.

PLEASE BE AWARE: In the interest of security, Dane Street will never conduct interviews via text or request checks for purchasing equipment.