Physician Reviewer
TMF Health Quality Institute
- Austin, Texas, United States
- Austin, Texas, United States
À propos
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.
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 Bank (NPDB)
Medicare regulations or review experience, preferred
Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)
C2C offers an excellent benefits package, including
Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
Section 125 plan
401K
Tuition Reimbursement
EOE Vet/Disability Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
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Compétences linguistiques
- English
Avis aux utilisateurs
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