Pulmonology Physician

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

Job summary

A healthcare services company is seeking a Pulmonology Physician to evaluate insurance claims and appeals. This telework position allows for a flexible schedule while adhering to turnaround times for case reviews. Candidates must hold an active Texas license and possess clinical expertise in medical necessity evaluations. Responsibilities include detailed documentation and consultations as needed.

Qualifications

• Must hold an active Texas License.
• Experience in evaluating medical necessity based on evidence-based guidelines.
• Ability to provide clear documentation for insurance appeals.

Responsibilities

• Review insurance appeals and claims based on client policies.
• Document decisions clearly and substantiate with evidence.
• Conduct telephone consultations as required.

Skills

Clinical Expertise

Medical Necessity Evaluation

Insurance Appeals

Health Records Review

Telehealth

Education

Active Texas License

Job description

Pulmonology Physician at Dane Street summary :

The Pulmonology Physician role involves reviewing insurance appeals and claims, utilizing clinical expertise to evaluate medical necessity based on client-specific policies and evidence-based guidelines. This telework position allows for a flexible schedule while ensuring timely case reviews, with responsibilities including documentation, telephone consultations, and maintaining proper credentials. The physician will work as a 1099 independent contractor, focused on providing clear and substantiated decisions while adhering to industry standards and regulations.

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 : PulmonaryDisease

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 :

• All of our physician reviewers are contractors with Dane Street.
• A flat rate is offered for Group Health Record / Policy Reviews.
• Reviews all medical records and addresses each question posed by the client utilizing client-specific criteria or other nationally recognized evidence-based criteria
• Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision
• 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
• Provides copies of any criteria utilized in a review with the report promptly
• Makes telephone calls as mandated by the state and / or client specifics
• Peer to Peer calls may be required. Dane Street will help arrange any Peer to Peer phone calls, if needed.
• The average length of time to review each case is between 15-30 minutes.
• The cases are prepared for you before they are provided for your review.
• Some cases may REQUIRE a short turnaround time meaning some cases may need to be reviewed the same day!
• Returns cases on or before the due date and time
• Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
• Attends all required orientation and training
• 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.

Keywords :

Pulmonology, Physician Reviewer, Medical Necessity, Insurance Appeals, Telehealth, Clinical Expertise, Health Records Review, Independent Contractor, Evidence-Based Guidelines, Patient Care