Medical Peer Reviewer - Utilization & Compliance

Healthfirst, Inc.; New York (NY); On-site; USD 122,907 - 188,020; Full time

Benefits offered by this job

Medical, dental and vision coverage

Incentive and recognition programs

Life insurance

401k contributions

Job summary

A healthcare company is seeking a Medical Peer Reviewer to play a critical role in consulting on medical necessity. This involves assessing requests for authorization and claims payment while ensuring compliance with regulatory policies. Candidates must possess an M.D. or D.O. and board certification. The role requires collaboration across departments and encompasses flexibility with workload and scheduling. Competitive salary range is $122,907 - $188,020, along with comprehensive benefits including medical, dental, and retirement plans.

Qualifications

• Required to have a valid medical license as M.D., D.O., D.M.D. or D.D.S.
• Requires board certification recognized by the American Board of Medical Specialties.
• Preferably board certified in Internal Medicine, Family Practice, OBGYN, or Emergency Medicine.

Responsibilities

• Assess and review requests for authorization and claims payment based on medical records.
• Render determinations within required formats and timeframes.
• Collaborate with various departments and manage caseloads.
• Complete mandatory compliance training.
• Enter hours worked in the system daily.

Skills

Time management

Critical thinking

Communication

Problem-solving

Education

Licensed M.D. or D.O. or D.M.D. or D.D.S.

Board Certified in a specialty

Job description

A healthcare company is seeking a Medical Peer Reviewer to play a critical role in consulting on medical necessity. This involves assessing requests for authorization and claims payment while ensuring compliance with regulatory policies. Candidates must possess an M.D. or D.O. and board certification. The role requires collaboration across departments and encompasses flexibility with workload and scheduling. Competitive salary range is $122,907 - $188,020, along with comprehensive benefits including medical, dental, and retirement plans.