Physician reviewer

Physician reviewer

Source To Win Consultancy
1-3 years
Not Specified

Job Description

Position: Physician reviewer
Years of Experience: 1+ Years
Shift : General
Location – Chennai
Job Description

  • Licenses and Certifications
  • M.B.B.S (Fresher / or 1 year of clinical experience)
  • MCI certification is not mandate
  • Preferred- clinical auditing experience
  • Doctor of Medicine from an accredited school
  • Currently licensed to practice under MCI (optional)
  • The responsibilities of the Physician Reviewer is to ensuring claims meet medical necessity criteria and are billed under the appropriate level of care by reviewing documentation provided in the medical records.
  • Ability to review physician and hospital documentation to validate medical necessity was met.
  • Clearly document clinical thought process when performing desk audits to ensure the findings are understandable and defendable.
  • Determine the correct level of care when discrepancies are identified using clinical decision making
  • Ability to review appeals submitted by facilities. Consider information/documentation provided and render clinical decisions with defendable rationale to either uphold or overturn original finding
  • Participate in Inter Rater Reliability quality reviews
  • Comply with all National Audit Employee Handbook policies and procedures
  • Comply with HIPAA and other regulations regarding confidentiality of information
  • Adhere to established NAS Audit Policies and Procedures other duties as assigned

Source To Win Consultancy

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