Board Certified Physician Reviewer - Plastic Surgery (Specializing in Lipedema) - Remote

Overview

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.

In Short

• Utilizes clinical expertise to review insurance appeals and claims.
• Interprets medical necessity of services provided by healthcare professionals.
• Reviews medical records and addresses client questions using specific criteria.
• Ensures clear and concise rationale for determinations with supporting documentation.
• Identifies and utilizes current criteria and resources for decision-making.
• Maintains proper credentialing and state licenses.
• Attends required orientation and training.
• Performs duties related to quality assurance and regulatory issues.
• Returns cases on or before the due date.
• Makes mandated telephone calls as required.

Requirements

• Experience in reviewing medical records and insurance claims.
• Knowledge of nationally recognized evidence-based guidelines.
• Ability to maintain proper credentialing and licenses.
• Strong communication skills for client interactions.
• Attention to detail in documentation and reporting.
• Ability to work independently as a contractor.
• Familiarity with quality assurance processes.
• Commitment to meeting deadlines.
• Willingness to attend training sessions.
• Understanding of regulatory compliance in healthcare.

Benefits

• Flexible schedule and caseload management.
• Work from home opportunity.
• Compensation on a per-case basis.
• Independence as a 1099 contractor.
• Opportunity to utilize clinical expertise.
• Engagement with a variety of cases.
• Access to professional development through training.
• Supportive work environment.
• Potential for long-term contract work.
• Contribution to quality assurance in healthcare.