Physician Reviewer - (Ophthalmology, Otolaryngology, OB/GYN) - Remote

Overview

This telework opportunity allows for a customizable schedule and caseload while ensuring compliance with client-mandated turnaround times. The role involves reviewing insurance appeals and claims based on clinical expertise.

In Short

• Telework opportunity with flexible scheduling
• Compensation on a per-case basis as a 1099 independent contractor
• Requires NM, TX, MN, and/or NC License
• Review medical records and address client questions
• Ensure clear rationale for determinations
• Utilize current criteria and resources for decision-making
• Maintain proper credentialing and state licenses
• Attend required orientation and training
• Respond to quality assurance issues and audits
• Conduct telephone calls as mandated

Requirements

• Must hold relevant state licenses
• Experience in reviewing insurance appeals
• Knowledge of medical necessity standards
• Ability to interpret medical records
• Strong communication skills
• Attention to detail in documentation
• Familiarity with evidence-based guidelines
• Ability to meet deadlines
• Willingness to participate in training
• Capability to handle quality assurance issues

Benefits

• Flexible work schedule
• Work from home
• Independent contractor status
• Opportunity to work in various specialties
• Potential for professional development