Physician Reviewer (Weekend Work)TMF Health Quality Institute • Austin, Texas, United States
Physician Reviewer (Weekend Work)
TMF Health Quality Institute
- Austin, Texas, United States
- Austin, Texas, United States
Über
*This position is located Remote United States*
*This can be a full-time or part-time role*
Position Purpose:
Provides dissatisfied beneficiaries and/or providers/suppliers the opportunity 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.
Essential Responsibilities:
- Writes, and may plan, a reconsideration decision that is clear and supports the determination made.
- Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, Centers for Medicare & Medicaid Services (CMS) policy, and local Medicare policy, or other authoritative sources.
- Ensures, and may plan, that all 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 practice, CMS contractor manuals, coverage issues manuals, and medical literature to complete an accurate and well-supported decision.
Minimum Qualifications
Education
- Doctor or PharmD degree from an accredited school
License and Certification
- Active State license to practice
- Board certification
Experience
- Five (5) to Seven (7) years of clinical or direct patient care
- No federal or state sanctions as would appear on reporting from the National Practitioner Data
Sprachkenntnisse
- English
Hinweis für Nutzer
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