Physician Medical Reviewer - Remote - PRN

Overview

Valor Healthcare is looking for a Medical Reviewer to join our team on a PRN or per diem basis supporting arbitration of Medicare/Medicaid evaluations.

In Short

• Part-time position, typically 4 hours a week with flexible hours.
• Focus on reviewing medical record documentation for Medicare Advantage organizations.
• Involves medical record intake and diagnosis abstraction.
• Support for medical record review appeals as per CMS guidelines.
• Requires experience in health insurance or related fields.
• Must be a licensed and board-certified doctor of medicine or osteopathy.
• Knowledge of ICD-9 and ICD-10 coding guidelines is preferred.
• Communicate with stakeholders including physician groups and organizations.
• Active CCA certification preferred.
• Must be licensed to practice in at least one US state.

Requirements

• Experience in health insurance or healthcare claims processing.
• Minimum three years practicing medicine.
• Active CCA certification preferred.
• Ability to interpret clinical guidelines and resolve disputes.
• Knowledge of coding guidelines and encoder software.
• Board-certified in a recognized specialty.
• Valid and unrestricted medical license.

Benefits

• Flexible working hours.
• Opportunity to work remotely.
• Engagement with important healthcare stakeholders.