Physician ED Claims Reviewer
Compensation
Pay not listed
The week · per this posting · weekdays assumed
Ask the employer about the pay range, weekend coverage, nights and shift pattern and time off.
Job Description
Role: Physician ED Claims Reviewer
Duration: 12 months
Required Skills
Physician with an active US licensed with experience in with medical coding (CPT/HCPCS) and managed care to conduct clinical review of claims and UM authorization requests for clinical necessity.
Minimum of recent (last 2-3 years) 3-5 clinical experience in emergency dept medicine, experience in internal medicine will be considered. Experience in managed care, clinical UM case reviews. Knowledge of claims and medical coding (CPT/HCPCS codes). Proficient working in various systems and applications.
Desired Skills
Experience/knowledge in utilization management is a plus. Ability to work independently in a fast paced environment.
This is a remote position.
Key Responsibilities
Conduct clinical reviews of claims and utilization management authorization requests to determine clinical necessity. Perform reviews specifically for emergency department and internal medicine cases.
Requirements
Requires a US licensed physician with 3-5 years of recent clinical experience in emergency or internal medicine. Must be proficient in medical coding (CPT/HCPCS) and have experience in managed care and UM case reviews.
Qualifications
- Education
- Professional certificate or licensure
- Experience
- 2+ years of experience
Key Skills
Emergency Medicine — Physician Career Context
Of the 50 active Emergency Medicine listings this role was benchmarked against, 4% are remote, 90% have no call, 58% require no weekends — this position is remote.
Nationally, Emergency Medicine professionals earn a median annual salary of approximately $350k, with the typical range spanning $270k to $450k depending on experience, location, and practice setting.
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- Remote
- Includes call