Pulmonology Physician

Dane Street; Town of Texas (WI); Remote; USD 60,000 - 80,000; Full time

Job summary

An innovative telework opportunity awaits skilled physician reviewers at a forward-thinking firm. This role allows for flexible scheduling while ensuring compliance with client-specific policies and nationally recognized guidelines. As a contractor, you'll utilize your clinical expertise to review insurance appeals and claims, providing critical insights into the medical necessity of services. With a focus on quality assurance and thorough documentation, your contributions will play a vital role in the healthcare decision-making process. If you are passionate about making a difference in the healthcare landscape, this position offers a unique chance to work independently while impacting patient care positively.

Qualifications

• Candidates must hold an active Texas License.
• Strong clinical expertise in reviewing insurance appeals and claims.

Responsibilities

• Review medical records and ensure clear rationale for determinations.
• Utilize evidence-based criteria and guidelines for decision-making.

Skills

Clinical Expertise

Medical Necessity Interpretation

Insurance Appeals Review

Evidence-Based Guidelines

Education

Active Texas License

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.

Candidates must hold an active Texas License.

Physician Specialties: Pulmonary Disease

JOB SUMMARY

Utilizes clinical expertise, reviews insurance appeals, and prospective and retrospective claims. The physician reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.

MAJOR DUTIES AND RESPONSIBILITIES:

1. All of our physician reviewers are contractors with Dane Street.
2. A flat rate is offered for Group Health Record/Policy Reviews.
3. Reviews all medical records and addresses each question posed by the client utilizing client-specific criteria or other nationally recognized evidence-based criteria.
4. Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision.
5. Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes.
6. Provides copies of any criteria utilized in a review with the report promptly.
7. Makes telephone calls as mandated by the state and/or client specifics.
8. Peer to Peer calls may be required. Dane Street will help arrange any Peer to Peer phone calls, if needed.
9. The average length of time to review each case is between 15-30 minutes.
10. The cases are prepared for you before they are provided for your review.
11. Some cases may REQUIRE a short turnaround time meaning some cases may need to be reviewed the same day!
12. Returns cases on or before the due date and time.
13. Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
14. Attends all required orientation and training.
15. Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.

PLEASE BE AWARE: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.