Board Certified-(M.D, D.O) Boston Family Practice Record Reviewer at Dane Street, LLC

Boston, Massachusetts, United States -

Full Time

Start Date

Immediate

Expiry Date

08 Mar, 26

Salary

0.0

Posted On

08 Dec, 25

Experience

10 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Expertise, Medical Necessity, Insurance Appeals, Claims Review, Documentation, Quality Assurance, Credentialing, State Licenses, Independent Medical Exams, Physician Advisor Services, Evidence-Based Guidelines, Standards of Care, Rationale Development, Peer-Reviewed Literature, Telephonic Communication, Regulatory Compliance

Industry

Insurance

Description

As Physician Reviewer/Advisor you will utilize 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 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 Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits Board certification required, active practice required PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment. Benefits Robust opportunity for supplemental income Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions. Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise Expanded credentials as an expert in Independent Medical Exams and physician advisor services Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal

Responsibilities

The Physician Reviewer will review medical records and provide interpretations of medical necessity based on client-specific and nationally recognized criteria. They will ensure clear documentation and timely return of cases while maintaining compliance with regulations.