Job Description

This flexible telework position allows you to create your own schedule and manage your caseload while adhering to client-mandated turnaround times. Our independent contractors are compensated per case as 1099 professionals. Specialty Requirement: Neurological Surgery - Must be Board Certified Job Summary Utilizing your clinical expertise, you will review insurance appeals, as well as prospective and retrospective claims. As a physician reviewer, you will assess the medical necessity of services provided by other healthcare professionals in alignment with client-specific policies, nationally recognized guidelines, and standards of care. Key Responsibilities: Contract as an independent reviewer with Dane Street. Receive a flat rate for conducting Group Health Record/Policy Reviews. Thoroughly review all medical records and respond to each query using client-specific criteria or other established guidelines. Ensure that your rationale for determinations is clear and substantiated with appropriate documentation. Utilize up-to-date criteria and resources, including national and professional guidelines, to support objective decision-making; avoid reliance on case studies with limited sample sizes. Provide documentation of any criteria used in your reviews with your reports. Make follow-up calls as required by state regulations or client specifics. Participate in Peer to Peer calls as necessary; support for arrangements will be provided by Dane Street. Expect an average review time of 15-30 minutes per case. Receive prepared cases for review. Be aware that some cases may have a same-day review requirement. Return evaluations by the designated due date and time. Maintain all necessary credentials, state licenses, and any required special certifications to effectively perform your role. Complete all mandatory orientation and training. Carry out additional duties as required, including addressing quality assurance matters, responding to complaints, and participating in audits or court appearances. Please Note: Dane Street prioritizes the security of both parties. We will never conduct interviews via text messages or request payment for equipment from candidates. Dane Street

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