Remote Physician Reviewer – Insurance Appeals & Guidelines

Dane Street, LLC; New Mexico; Remote; USD 137,760 - 206,640; Part time

Job summary

A healthcare review company is seeking a Physician Reviewer to work telecommuting. This role utilizes clinical expertise to review insurance appeals and claims. Candidates must possess an active NM License and have a solid understanding of evidence-based guidelines. Responsibilities include reviewing medical records, ensuring documentation quality, and maintaining licensure. This role offers a custom schedule as a 1099 independent contractor.

Qualifications

• Must hold an active NM License.
• Familiarity with evidence-based guidelines.
• Ability to critique and utilize current medical criteria.

Responsibilities

• Review medical records and address client questions.
• Ensure clear and concise rationale for decisions.
• Identify and utilize professional guidelines and literature.
• Return cases before the due date.
• Maintain proper credentialing and licenses.
• Attend required orientation and training.

Skills

Clinical expertise

Ability to interpret medical necessity

Strong documentation skills

Education

Active NM License

Job description

A healthcare review company is seeking a Physician Reviewer to work telecommuting. This role utilizes clinical expertise to review insurance appeals and claims. Candidates must possess an active NM License and have a solid understanding of evidence-based guidelines. Responsibilities include reviewing medical records, ensuring documentation quality, and maintaining licensure. This role offers a custom schedule as a 1099 independent contractor.