Job Description

Nephrology Physician at Dane Street summary:

A Nephrology Physician contractor reviews medical records and insurance appeals to evaluate the medical necessity of healthcare services using evidence-based guidelines and client-specific policies. This telework role involves timely case reviews, clear documentation, and occasional peer-to-peer calls, ensuring compliance with regulatory and quality standards. Reviewers are independent contractors compensated per case and must maintain proper credentials and licenses.

This telework opportunity allows you to customize your schedule and caseload within the week while maintaining client-mandated turnaround times. Our reviewers are compensated on a per-case basis as a 1099 independent contractor.

JOB SUMMARY

Utilizes clinical expertise, reviews insurance appeals, and prospective and retrospective claims. The physician reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.

MAJOR DUTIES AND RESPONSIBILITIES:

• All of our physician reviewers are contractors with Dane Street.
• A flat rate is offered for Group Health Record/Policy Reviews.
• 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 promptly
• Makes telephone calls as mandated by the state and/or client specifics
• Peer to Peer calls may be required. Dane Street will help arrange any Peer to Peer phone calls, if needed.
• The average length of time to review each case is between 15-30 minutes.
• The cases are prepared for you before they are provided for your review.
• Some cases may REQUIRE a short turnaround time meaning some cases may need to be reviewed the same day!
• Returns cases on or before the due date and time
• Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
• Attends all required orientation and training
• Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits

PLEASE BE AWARE: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.

Keywords:

Nephrology, Physician Review, Medical Necessity, Insurance Appeals, Telework, Medical Records Review, Evidence-Based Guidelines, Healthcare Compliance, Independent Contractor, Peer-to-Peer Calls

Job Tags

Price work, For contractors, Full time, Remote work,

Similar Jobs