Physician Reviewer - (Radiation Oncology, Cardiology, Rheumatology)

Dane Street; Dallas (TX); Remote; USD 75,000 - 100,000; Full time

Job summary

Dane Street is seeking a Physician Reviewer to utilize clinical expertise for reviewing insurance appeals and claims. This remote role allows for flexible scheduling, and involves ensuring compliance with client policies while maintaining required credentials. Candidates should hold relevant licenses in specified states.

Qualifications

• Holds active licenses in NM, TX, MN, and/or NC.
• Entry-level role, requires clinical expertise.

Responsibilities

• Reviews medical records and addresses client questions.
• Ensures documentation for decisions is clear and concise.
• Returns cases on or before the due date.

Skills

Clinical expertise

Medical necessity interpretation

Job description

Join to apply for the Physician Reviewer - (Radiation Oncology, Cardiology, Rheumatology) role at Dane Street.

This telework opportunity offers flexible scheduling and caseload management within client-mandated turnaround times. Reviewers are compensated on a per-case basis as independent contractors (1099).

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 policies, evidence-based guidelines, and standards of care.

Major Duties and Responsibilities

• Reviews medical records and addresses client questions using specific criteria or recognized standards.
• Ensures clear, concise rationale with adequate documentation for decisions.
• Utilizes current guidelines and literature to support objective decision-making, avoiding limited sample case studies.
• Provides copies of criteria used prior to case review deadline.
• Returns cases on or before the due date.
• Makes mandated phone calls.
• Maintains proper credentials and licenses.
• Attends required training and orientation.
• Performs additional duties, including responding to QA issues, complaints, regulatory matters, and audits.

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

Additional Information

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Healthcare Provider
• Industry: Insurance

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