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Dane Street · 2 months ago

Board Certified-(M.D, D.O) South Carolina Diagnostic Radiology Advisor

United States

Full-time

Remote

Senior Level

Dane Street is a healthcare company seeking a Board Certified Physician Reviewer/Advisor for remote work. In this role, you will utilize your clinical expertise to review insurance appeals and claims, ensuring compliance with guidelines and standards of care while providing clear documentation and rationale for decisions.

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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

Qualification

Board CertificationClinical ExpertiseMedical Record ReviewInsurance AppealsCredentialingEvidence-Based GuidelinesQuality AssuranceCommunication Skills