What are the responsibilities and job description for the Physician Reviewer position at Visual Connections (SDVOSB)?
Physician Reviewer
Visual Connections (VC) is seeking a part time Physician Reviewer to work 4 hours a week on the MRRC contract. The Physician Reviewer must have knowledge of the Medicare program, and be capable of effectively interpreting and resolving disagreements regarding clinical guidelines.
Working knowledge of ICD-9-CM and ICD-10-CM code sets, official coding guidelines and clinics, and encoder software use in code abstraction are preferred.
Primary Roles & Responsibilities:
- Evaluate the medical records submitted by the MA organizations and abstract diagnoses in accordance with the ICD-9 and ICD-10-CM coding guidelines
- Reexamine disputed medical records for CMS during the appeals process.
- Communicate and work with important program stakeholders, such as with physician groups, beneficiary organizations, and/or congressional offices
- Complete assigned tasks
General Qualifications:
- Must be a US Citizen
- Practiced medicine for a minimum of three (3) years as a licensed and board-certified Doctor of Medicine or osteopathy.
- Experience in the health insurance industry, a utilization review firm, or health care claims processing organization
Education Requirements
The Physician Reviewer must be a board-certified Doctor of Medicine or a Doctor of Osteopathy in a specialty recognized by the American Board of Medical Specialties. The Physician Reviewer must have been board certified for at least three (3) years. The Physician Reviewer must have an active, valid and unrestricted license and must be currently licensed to practice in at least one US state.