Board Certified-(M.D, D.O) South Carolina Diagnostic Radiology Advisor
Dane Street · US
As a Physician Reviewer/Advisor, you will utilize clinical expertise and review insurance appeals, prospective and retrospective claims.
Job description
As a Physician Reviewer/Advisor, you will utilize clinical expertise and review insurance appeals, 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: PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment. - 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 ca...