Otolaryngology Partnership job located in Kentucky

• Contract
• Claims Review
• Remote

We are actively seeking experienced Claims Review Physicians to join our panel at (Login for Information). This is a remote, 1099 contractor role.

The Claims Review Position will play a crucial role in the fair and efficient resolution of claim disputes. You will be responsible for resolving claim disputes submitted by various parties such as physicians, hospitals, institutions, pharmacies, and other licensed healthcare providers. Additionally, you will provide assistance to contracted and non-contracted healthcare providers and health care plans for resolution of claims disputes.

Key Responsibilities:
Conduct impartial assessment of documentation from both initiating and responding parties.
Review medical documentation to make a determination of the medical necessity or appropriateness of each service/procedure listed in a dispute.
Utilize governmental and professional guidelines to support the determination on medical necessity or appropriateness of each service/procedure listed in a dispute.
Adhere to company policies, state regulations, and specific project guidelines.
Maintain effective communication.
Ensure timely completion of reviews within assigned deadlines.
Follow established QA/QC processes and meet company/departmental standards.
Uphold scheduling commitments and privacy regulations.
Perform other related duties as directed by leadership.

Specialties of Focus:
Cardiology
Oncology
Ophthalmology
Orthopedics
Otolaryngology
Nephrology
Neurology
Psychiatry
Pediatrics
Dermatology
Endocrinology
Gastroenterology
Pulmonology
Pain Medicine/Anesthesiology
Diagnostic Radiology

Qualifications:
Licensed in required Specialty.
Five years full-time equivalent experience providing direct clinical care to patients.
Experience providing direct clinical care to patients within the past three years.
Hold a non-restricted license in any state in the US.
For physicians, a current certification by a recognized American medical specialty board in the area or areas appropriate to the condition or treatment under review.
Preferred Qualifications:
Familiarization with claims.
Knowledge of claim review processes.
Familiarization with navigating electronic documents like PDFs, Microsoft Excel, Microsoft Word and experience using Microsoft Outlook.
Exceptional skills in managing sensitive and confidential information.
Strong organizational abilities, written, and verbal communication skills in English.
Ability to work both independently and collaboratively.
Skilled in prioritizing tasks to align with business needs and assignments.

Compensation: Approximately $250 per case depending on case requirements.

Employment is contingent on successful passing of a background check.

(Login for Information) LLC. is an Equal Opportunity Employer.

To learn more and apply, visit our careers page:
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