Physician ED Claims Reviewer

Required Skills

• Physician with an active US licensed with experience in medical coding (CPT/HCPCS) and managed care
• To conduct clinical review of claims and UM authorization requests for clinical necessity
• Minimum of recent (last 2-3 years) 3-5 clinical experience in emergency dept medicine, experience in internal medicine will be considered
• Experience in managed care, clinical UM case reviews
• Knowledge of claims and medical coding (CPT/HCPCS codes)
• Proficient working in various systems and applications

Desired Skills

• Experience/knowledge in utilization management
• Ability to work independently in a fast paced environment
• Strong Agile experience: user story development, requirements gathering, and portfolio management

Mandatory Skills

• Agile Scrum Methodology
• Experience: 5-8 Years

Pay

The expected compensation for this role ranges from $60,000 to $135,000. Final compensation will depend on various factors, including your geographical location, minimum wage obligations, skills, and relevant experience.

Benefits

• Full range of medical and dental benefits options
• Disability insurance
• Paid time off (inclusive of sick leave)
• Other paid and unpaid leave options