Board Certified Physician Reviewer (MD/DO) - Pediatrics (Multiple Specialties)

This telework opportunity allows you to customize your schedule and caseload reputed company the week while maintaining client-mandated turnaround times. Our reviewers are compensated on a per-case basis as a 1099 reputed company. Physician Specialty: Pediatrics -Must be Board Certified or Subspecialty in the following - (Neurology, Pathology, Critical Care Medicine, Emergency Medicine, Dermatology, Nephrology, Infectious Disease, Neurological Surgery, Radiology, Pulmonary, Rheumatology, Rehab Medicine, Orthopedics, Surgery, Urology, Hematology/Oncology) JOB SUMMARY Utilizes 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 reputed company in compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care. MAJOR DUTIES AND RESPONSIBILITIES: • Reviews reputed company 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 reputed company 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; refrains from using case studies, cohorts, and the like to reputed company decisions due to their limited sample sizes • Provides copies of any criteria utilized in a review with the report on time • 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 and state licenses and any special certifications or requirements necessary to reputed company the job • Attends reputed company required orientation and training • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits PLEASE BE AWARE: In the interest of the reputed company of both parties, please be aware that reputed company will never conduct an interview reputed company text or request checks from candidates for purchasing equipment. Apply Job!