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AI Summary
Conduct clinical reviews of claims and utilization management authorization requests to determine clinical necessity. Perform reviews specifically for emergency department and internal medicine cases.
Role: Physician ED Claims Reviewer
Duration: 12 months
Required skills: Physician with an active US licensed with experience in with medical coding (CPT/HCPCS) and managed care to conduct clinical review of claims and UM authorization requests for clinical necessity.
Minimum of recent (last 2-3 years) 3-5 clinical experience in emergency dept medicine, experience in internal medicine will be considered. Experience in managed care, clinical UM case reviews. Knowledge of claims and medical coding (CPT/HCPCS codes). Proficient working in various systems and applications.
Desired skills: Experience/knowledge in utilization management is a plus. Ability to work independently in a fast paced environment.
Duration: 12 months
Required skills: Physician with an active US licensed with experience in with medical coding (CPT/HCPCS) and managed care to conduct clinical review of claims and UM authorization requests for clinical necessity.
Minimum of recent (last 2-3 years) 3-5 clinical experience in emergency dept medicine, experience in internal medicine will be considered. Experience in managed care, clinical UM case reviews. Knowledge of claims and medical coding (CPT/HCPCS codes). Proficient working in various systems and applications.
Desired skills: Experience/knowledge in utilization management is a plus. Ability to work independently in a fast paced environment.
This is a remote position.
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