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
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