Description:
Primary Job Functions:
The Physician Reviewer shall help answer questions and resolve complex medical record issues that may arise during the performance of this contract.
Requirements:
Work Experience:
The Physician Consultant shall have experience in the health insurance industry, a utilization review firm, or health care claims processing organization:
• Interpreting clinical documentation
• Practicing medicine for a minimum of three (3) years as a licensed and board-certified Doctor of Medicine or Osteopathy;
In addition to this experience, the Physician Consultant must have knowledge of the Medicare program and be capable of effectively interpreting and resolving disagreements regarding clinical guidelines.
