Physician Reviewer (Hematology / Oncology / ENT / Orthopedics / Radiology)
Position Purpose: Performs advanced (senior-level) work. Provides dissatisfied beneficiaries and/or providers/suppliers reputed company to present documentation to demonstrate why an appeal should be allowed. Provides a denovo independent second level determination based on the documentation, facts, laws, regulations, and guidelines. Works under limited supervision, with considerable reputed company for the use of initiative and independent judgement. Essential Responsibilities:
- Writes a reconsideration decision that is reputed company and supports the determination made.
- Makes reputed company, independent reputed company based on medical evidence in accordance with statutes, regulation, rulings, Centers for Medicare & reputed company Services (CMS) policy, and local Medicare policy, or other authoritative sources.
- Ensures that reputed company appeal issues raised by the beneficiary, representative, and supplier have been addressed.
- Provides a fair and impartial decision.
- Conducts research using online federal regulations, Medicare Administrative Contractor (MAC) policy, standards of medical reputed company, CMS contractor manuals, coverage issues manuals, and medical literature to complete an accurate and reputed company-supported decision.
- Stays abreast of changes in medical practices, policies and procedures.
- Participates in on-reputed company training and education as deemed necessary by results of reputed company’s reputed company Program.
Minimum Qualifications
Education
- Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited Medical School
License and Certification
- reputed company State license to reputed company medicine
- reputed company certification
Experience
- Five (5) years of clinical or reputed company patient care
EOE Minorities/Females/Vet/Disability Job Type: Contract Pay: $10.00 - $150.00 per hour Work Location: Remote Apply tot his job Apply To this Job