Physician Reviewer Jobs

Physician Reviewer Experience, Education, Skills, Abilities requested:

Apply knowledge of the Medicare Advantage program and related data or records to identify and address coding and documentation issues.

Assist in the development and implementation of coding education and training programs for healthcare providers to improve documentation and coding accuracy.

Collaborate with internal and external stakeholders to address coding-related queries, resolve issues, and provide guidance on coding and documentation requirements.

Experience in the health insurance industry, a utilization review firm, or health care claims processing organization.

In-depth knowledge of ICD-9-CM and ICD-10-CM coding guidelines and the ability to apply them accurately and consistently.

Five (5) years’ experience in healthcare delivery performing preservice reviews

Reviews preservice laboratory testing services requests for medical necessity and correct coding

Serves as a resource for information and consultation on Preservice review issues

Consults with ordering provider during Peer-to-Peer reviews

Documents decision rationale for members and providers in clear, concise and understandable language

Other duties as assigned or requested