State Licensed Physician Reviewer

A company is looking for a Physician Medical Reviewer to support arbitration of Medicare/Medicaid evaluations on a part-time, fully remote basis. Key Responsibilities Review medical record documentation to verify diagnoses submitted by Medicare Advantage organizations Abstract diagnoses from medical records in accordance with ICD-9 and ICD-10-CM coding guidelines Support the appeals process for disputed CMS-HCC results by reexamining medical records Required Qualifications, Training, and Education Minimum of three years of experience as a licensed and board-certified doctor of medicine or osteopathy Experience in the health insurance industry, utilization review, or health care claims processing Knowledge of the Medicare program and ability to interpret clinical guidelines Working knowledge of ICD-9-CM and ICD-10-CM code sets and encoder software Must hold an active, valid, and unrestricted medical license in at least one US state

Feb 21, 2025 - 01:46

A company is looking for a Physician Medical Reviewer to support arbitration of Medicare/Medicaid evaluations on a part-time, fully remote basis. Key Responsibilities Review medical record documentation to verify diagnoses submitted by Medicare Advantage organizations Abstract diagnoses from medical records in accordance with ICD-9 and ICD-10-CM coding guidelines Support the appeals process for disputed CMS-HCC results by reexamining medical records Required Qualifications, Training, and Education Minimum of three years of experience as a licensed and board-certified doctor of medicine or osteopathy Experience in the health insurance industry, utilization review, or health care claims processing Knowledge of the Medicare program and ability to interpret clinical guidelines Working knowledge of ICD-9-CM and ICD-10-CM code sets and encoder software Must hold an active, valid, and unrestricted medical license in at least one US state