Surgery - Transplant Physician

Dane Street; Alaska; Remote; USD 104,000 - 208,000; Full time

Job summary

Dane Street is seeking a Physician Reviewer specializing in Organ Transplant to utilize clinical expertise in reviewing insurance appeals and claims. This telework role allows for a customizable schedule while ensuring compliance with guidelines and client policies. Responsibilities include reviewing medical records, providing clear determinations, and maintaining required credentials. Join a team that values thoroughness and quality assurance in healthcare.

Qualifications

• Maintains proper credentials, licenses, and certifications required for the role.

Responsibilities

• Reviews insurance appeals and claims, ensuring compliance with guidelines.
• Addresses client questions using specific criteria.
• Returns cases on or before the due date.

Skills

Clinical Expertise

Medical Necessity Interpretation

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.

Physician Specialties: Organ Transplant (Solid Organ and BMT, including Lung, Heart, Kidney, Liver)

JOB SUMMARY

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

MAJOR DUTIES AND RESPONSIBILITIES:

• All 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 using client-specific criteria or other nationally recognized evidence-based criteria.
• Ensures that the rationale for the determination is clear, concise, and supported by adequate documentation.
• Utilizes current criteria and resources such as national, state, and professional guidelines, peer-reviewed literature, avoiding limited-sample case studies or cohorts.
• Provides copies of criteria used in the review with the report promptly.
• Makes necessary telephone calls as mandated by state and/or client specifics.
• Peer-to-peer calls may be required; Dane Street will assist in arranging these calls if needed.
• The average review time per case is between 15-30 minutes.
• Cases are prepared beforehand for review.
• Some cases may require same-day review due to short turnaround times.
• Returns cases on or before the due date and time.
• Maintains proper credentials, licenses, and certifications required for the role.
• Attends all required orientation and training sessions.
• Performs additional duties as assigned, including addressing quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits.

PLEASE BE AWARE: For security reasons, Dane Street will never conduct interviews via text nor request checks from candidates for equipment purchases.