Board Certified-Minnesota Licensed Physicians (M.D, D.O.) - Multiple Specialties
Posted 7 days ago by 1748950263
Negotiable
Outside
Remote
Remote
Summary: This role is for Board Certified physicians licensed in Minnesota to review insurance appeals and claims, ensuring compliance with client policies and evidence-based guidelines. The position allows for a flexible schedule as a 1099 independent contractor, focusing on various specialties including Gastroenterology and Oncology. The physician reviewer will utilize their clinical expertise to assess medical necessity and provide clear documentation for decisions made.
Key Responsibilities:
- 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; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes
- Provides copies of any criteria utilized in a review with the report in a timely manner
- 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 perform the job
- Attends all 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
Key Skills:
- Active Minnesota medical license
- Board certification in relevant specialties
- Clinical expertise in reviewing medical necessity
- Strong documentation and communication skills
- Ability to adhere to client-specific policies and evidence-based guidelines
- Experience with insurance appeals and claims
- Knowledge of national, state, and professional association guidelines
- Ability to work independently as a 1099 contractor
Salary (Rate): undetermined
City: undetermined
Country: undetermined
Working Arrangements: remote
IR35 Status: outside IR35
Seniority Level: undetermined
Industry: Other
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.
Candidates must hold an active Minnesota license.
Physician Specialties: Gastroenterology, Medical Oncology, Hematology, Otolaryngology , Plastic Surgery, Pain Management, OB/GYN, Neurology, General Surgery, Dermatology, Endocrinology, Orthopedic Surgery-Spine.
JOB SUMMARY
Utilizes clinical expertise, 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.
MAJOR DUTIES AND RESPONSIBILITIES:
- 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; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes
- Provides copies of any criteria utilized in a review with the report in a timely manner
- 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 perform the job
- Attends all 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 security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.