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AI Summary
Perform blinded Independent Review clinical evaluations to assess medical necessity and adherence to Medicare guidelines. Collaborate on the development of rebuttals and contribute to escalation decisions.
Position: Physician Auditor - Contingent
Location: Remote
Type: Part-Time
*This position is contingent upon the successful award of the associated contract. Employment is not guaranteed until the contract is awarded, and the position is officially activated. Job responsibilities and requirements are subject to change.
About J29
J29 is an employee centered healthcare management consulting company that specializes in processing, reviewing, and analyzing medical claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizes the employee experience. Our team brings corporate performance that stretches to various areas where we can provide our clinical, healthcare policy, and compliance expertise through our support to health and human service programs at the State, Federal, and Commercial levels.
Responsibilities:
Location: Remote
Type: Part-Time
*This position is contingent upon the successful award of the associated contract. Employment is not guaranteed until the contract is awarded, and the position is officially activated. Job responsibilities and requirements are subject to change.
About J29
J29 is an employee centered healthcare management consulting company that specializes in processing, reviewing, and analyzing medical claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizes the employee experience. Our team brings corporate performance that stretches to various areas where we can provide our clinical, healthcare policy, and compliance expertise through our support to health and human service programs at the State, Federal, and Commercial levels.
Responsibilities:
- Perform blinded Independent Review (IRR) clinical evaluations, assessing medical necessity, appropriateness of care, and adherence to Medicare guidelines.
- Collaborate in the development of rebuttals and contribute to informed escalation decisions as needed.
- 10+ years clinical practice; experience in peer review, utilization review, or appeals
- Familiarity with CMS/QIO processes preferred.
- Licensed MD or DO in the U.S.; active, unrestricted license required.
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