Physician Reviewer: Orthopedic Surgery - Spine Surgeon

Dane Street; West Palm Beach (FL); Remote; USD 60,000 - 120,000; Full time

Job summary

Dane Street is seeking a Physician Reviewer specializing in Orthopedic Surgery to join a flexible telework position. The role demands strong clinical expertise to evaluate insurance appeals and claims, ensuring compliance with established medical guidelines while managing a caseload as an independent contractor.

Qualifications

• Must possess an active Medical Doctor license.
• Clinical expertise in orthopedic surgery is required.
• Familiarity with insurance claims and procedures is preferred.

Responsibilities

• Review medical records and respond to client questions using established standards.
• Provide rationale for decisions with adequate documentation.
• Ensure all cases are returned by the due date with proper credentials maintained.

Skills

Clinical expertise

Medical necessity interpretation

Knowledge of insurance policies

Evidence-based guidelines

Education

Medical Doctor (MD)

Active medical license

Job description

Physician Reviewer: Orthopedic Surgery - Spine Surgeon

Join to apply for the Physician Reviewer: Orthopedic Surgery - Spine Surgeon role at Dane Street.

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

Job Summary

Utilizes clinical expertise to review insurance appeals, and both prospective and retrospective claims. Provides interpretation of the medical necessity of services by healthcare professionals, in 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 adequate supporting documentation for decisions.
• Utilizes current criteria and resources such as national, state, and professional guidelines, avoiding limited sample size case studies.
• Provides copies of criteria used in reviews promptly.
• Returns cases by the due date and time.
• Makes mandated phone calls as required by state or client.
• Maintains proper credentials, licenses, and certifications.
• Attends all required training and orientation.
• Performs additional duties including responding to quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits.

PLEASE BE AWARE: Dane Street will never conduct interviews via text or request checks for equipment purchases.

Seniority level

• Entry level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Insurance

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