Diagnostic Radiology- Medical Record Reviewer

Major Duties and 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 promptly
• 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, 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

Qualifications

• Board certification required
• Active practice required

Skills

• Expertise in clinical reviews and interpretations
• Ability to adhere to client-specific and evidence-based criteria
• Knowledge of national, state, and professional association guidelines
• Proficiency in utilizing peer-reviewed literature for decision-making
• Strong communication skills for providing rationale and supporting documentation
• Ability to manage multiple cases and deadlines effectively

Benefits

• Robust opportunity for supplemental income
• Schedule flexibility and predictable work hours
• No doctor/patient relationship established, no treatment provided
• Enhanced industry expertise through independent medical exam and physician advisor services
• Prepared and streamlined case flow
• User-friendly work portal