About the job
Join our dynamic team as a Spine Surgeon specializing in orthopedic surgery, with the flexibility to tailor your schedule and manage your caseload from the comfort of your home. This telework position ensures that you can meet client-mandated turnaround times while enjoying a work-life balance. As a valued Physician Reviewer, you will be compensated on a per-case basis as an independent contractor (1099).
To be considered for this role, candidates must possess an active NV License.
JOB SUMMARY
In this role, you will leverage your clinical expertise to review insurance appeals and both prospective and retrospective claims. You will provide critical interpretations regarding the medical necessity of services rendered by other healthcare professionals, ensuring compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.
MAJOR DUTIES AND RESPONSIBILITIES:
- Conduct comprehensive reviews of medical records, addressing each inquiry from clients using specified criteria or widely recognized evidence-based guidelines.
- Ensure that the rationale for your determinations is articulated clearly, concisely, and backed by adequate documentation to substantiate your decisions.
- Identify and utilize current criteria and resources, including national, state, and professional association guidelines and peer-reviewed literature, to support objective decision-making; avoid reliance on limited sample case studies.
- Provide timely copies of any criteria used in your reviews along with your reports.
- Return cases before or by stipulated deadlines.
- Make necessary telephone calls as dictated by state regulations and/or client requirements.
- Maintain appropriate credentialing, state licenses, and any additional certifications necessary for the role.
- Attend mandatory orientation and training sessions.
- Perform other assigned tasks, including addressing quality assurance issues, complaints, regulatory matters, depositions, court appearances, and audits.
IMPORTANT NOTE: For the security of both parties, please be advised that Dane Street will never conduct interviews via text or request checks from candidates for purchasing equipment.