Diagnostic Radiology Medical Record Reviewer - Remote

Overview

As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and 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.

In Short

• 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
• Provides copies of any criteria utilized in a review with the report promptly
• Returns cases on or before the due date and time
• Makes telephone calls as mandated by the state and/or client specifics
• Maintains proper credentialing, state licenses, and any special certifications or requirements necessary to perform the job
• Performs other duties as assigned, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits
• Board certification required, active practice required

Requirements

• Board certification required
• Active practice required
• Clinical expertise in medical reviews
• Experience with insurance appeals

Benefits

• Flexible working hours
• Opportunity to work remotely
• Engagement in meaningful work