Physician Reviewer (Hematology, Oncology)

Position Purpose: Performs advanced (senior-level) work. Provides dissatisfied beneficiaries and/or providers/suppliers the opportunity to present documentation to demonstrate why an appeal should be allowed. Provides a denovo independent second level determination based on the documentation, facts, laws, regulations, and guidelines. Works under limited supervision, with considerable latitude for the use of initiative and independent judgement. EssentialResponsibilities: • Writes a reconsideration decision that is clear and supports the determination made.• Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, Centers for Medicare & Medicaid Services (CMS) policy, and local Medicare policy, or other authoritative sources. • Ensures that all appeal issues raised by the beneficiary, representative, and supplier have been addressed. • Provides a fair and impartial decision. • Conducts research using online federal regulations, Medicare Administrative Contractor (MAC) policy, standards of medical practice, CMS contractor manuals, coverage issues manuals, and medical literature to complete an accurate and well-supported decision.• Stays abreast of changes in medical practices, policies and procedures. • Participates in on-going training and education as deemed necessary by results of the company’s Quality Program. Minimum Qualifications Education • Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited Medical School License and Certification • Active State license to practice medicine • Board certification Experience • Five (5) years of clinical or direct patient care EOE Minorities/Females/Vet/Disability Job Type: Contract Pay: $10.00 - $150.00 per hour Work Location:Remote Apply tot his job