Utilize clinical expertise to review insurance appeals, prospective and retrospective claims, and provide interpretations of medical necessity in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care.
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 to support sound and objective decision-making
- Provides copies of any criteria utilized in a review with the report
- 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
Benefits
- Robust opportunity for supplemental income
- Schedule flexibility and predictable work hours
- Enhanced industry 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