Physician Reviewer - (Ophthalmology, Otolaryngology, OB/GYN)

Dane Street; Charlotte (NC); Remote; USD 80,000 - 120,000; Full time

Job summary

An established industry player is seeking a Physician Reviewer with expertise in Ophthalmology, Otolaryngology, and OB/GYN. This exciting telework position allows for flexible scheduling while ensuring compliance with client policies and standards of care. The ideal candidate will leverage their clinical knowledge to review insurance appeals and claims, providing clear rationales and maintaining proper licensing. Join a dynamic team where your contributions will significantly impact patient care and compliance in the healthcare sector.

Qualifications

• Holds a valid medical license in NM, TX, MN, and/or NC.
• Utilizes clinical expertise to ensure compliance with medical standards.

Responsibilities

• Reviews medical records and addresses client questions using evidence-based standards.
• Ensures documentation supports decisions and meets client turnaround times.

Skills

Clinical Expertise

Medical Necessity Interpretation

Evidence-Based Guidelines

Credentialing and Licensing

Education

Medical License

Job description

Physician Reviewer - (Ophthalmology, Otolaryngology, OB/GYN)

4 weeks ago Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

This telework opportunity allows you to customize your schedule and caseload within the week while maintaining client-mandated turnaround times. Reviewers are compensated on a per-case basis as 1099 independent contractors.

Preferred candidates will hold licenses in NM, TX, MN, and/or NC.

Physician Specialties: Radiation Oncology, Cardiology, Rheumatology, Ophthalmology, Otolaryngology, OB/GYN, Hematology/Oncology

Job Summary

Utilizes clinical expertise to review insurance appeals, and prospective and retrospective claims. Provides interpretation of the medical necessity of services, ensuring compliance with client-specific policies, evidence-based guidelines, and standards of care.

Major Duties and Responsibilities

• Reviews all medical records and addresses client questions using specific criteria or recognized evidence-based standards
• Ensures clear, concise rationale with supporting documentation for decisions
• Utilizes current criteria and resources such as guidelines and peer-reviewed literature; avoids limited sample size case studies for decision-making
• Provides copies of utilized criteria prior to case submission
• Returns cases on or before the due date and time
• Makes mandated phone calls
• Maintains proper credentialing, licenses, and certifications
• Attends required orientation and training
• Performs additional duties, including responding to quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits

Notice: Dane Street will never conduct interviews via text or request checks for equipment purchases for security reasons.

Seniority Level

• Entry level

Employment Type

• Full-time

Job Function

• Health Care Provider

Industries

• IT Services and IT Consulting

Referrals can double your chances of interviewing at Dane Street.

Set up job alerts for “Medical Doctor” roles.