Board Certified Physician Reviewers - Hematology/Medical Oncology

Board Certified Physician Reviewers - Hematology/Medical Oncology. This telework opportunity allows you to customize your schedule and caseload within the week while maintaining client-mandated turnaround times. Reviews insurance appeals, and prospective and retrospective claims, utilizing clinical expertise and national guidelines.

Requirements

• Reviews all medical records and addresses each question posed by the client
• Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation
• Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature
• 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