Board Certified-(M.D, D.O) Oklahoma City Cardiology Advisor-Certified for IME

About the role

The Physician Reviewer/Advisor will utilize clinical expertise to review insurance appeals, prospective and retrospective claims, and interpret the medical necessity of services provided by other healthcare professionals.

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
• 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

Requirements

• Board certification required
• Active practice required

Qualifications

• No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions.
• Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management 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

Benefits

• Robust opportunity for supplemental income
• Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability

Pay

N/A

Schedule

N/A

Skills

N/A

Benefits

• Robust opportunity for supplemental income
• Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability
• No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions.
• Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management 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