Physician Reviewer Dentist or Orthodontist - Licensed in Indiana
Compensation
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Job Description
Physician Peer Reviewer – Dentist or Orthodontist -Licensed in Indiana
Overview
Federal Hearings and Appeals Services (FHAS) is a URAC-accredited Independent Medical Review Organization (IRO) with Health Utilization Management (HUM) accreditation. For the past 30 years, FHAS has provided external peer review services to healthcare organizations, government agencies, insurance companies, and legal entities.
FHAS is currently expanding its elite panel of physicians licensed in the state of Indiana to assist with independent review claims and appeals in the following specialties:
Dentist
Orthodontist
Description
- Responsible for reviewing medical case files and making medical determinations. Cases may include medical necessity and medical appropriateness, experimental or investigational treatment, administrative or legal issues, or a combination of these categories, which are filed with the Department of Human Services’ Bureau of Hearings and Appeals (BHA).
- Reviews and analyzes Federal and State laws, regulations, and applicable policy guides
- Completes and evaluates the review process in a regulatory timeframe.
Work Experience Requirements
- Successful completion of a Residency or Fellowship Program
- Must possess a current state license in a state of the United States/recognized in the relevant jurisdictions as a Doctor of Medicine or Doctor of Osteopathic Medicine and if required by contract, licensed in the state in which requests the review.
- License is unrestricted and if there is a restriction that is allowed by a relevant jurisdiction, according to the medical director or clinical director, it is of the type that does not affect the health professional’s ability to fulfill the roles and responsibilities of a reviewer.
- License is of the type and scope that permits applying clinical judgement in consideration of an individual members clinical needs to render a decision.
- For either a Doctor of Medicine or Doctor of Osteopathic Medicine, possess the same license or certification as the ordering practitioner.
- Must hold a current board certification issued by the American Board of Medical Specialties or American Osteopathic Association.
- 5-years or more post graduate clinical experience in direct patient care
- Experience providing direct patient care within the past 3 years, if performing external reviews
Job Type: Contract
Work Location: Remote
Key Responsibilities
The reviewer is responsible for examining medical case files to make determinations regarding medical necessity, appropriateness, experimental treatments, or administrative/legal issues for claims filed with the Bureau of Hearings and Appeals. This involves analyzing Federal and State laws, regulations, and policy guides to complete the review process within regulatory timeframes.
Requirements
Candidates must be a licensed Dentist or Orthodontist in Indiana, having successfully completed a Residency or Fellowship Program and possessing 5 or more years of post-graduate clinical experience in direct patient care, with recent patient care experience within the last three years. Applicants must hold current, unrestricted board certification and a license scope that permits rendering clinical judgment decisions.
Qualifications
- Education
- Professional certificate or licensure
- Experience
- 5+ years of experience
Key Skills
Work-Life Balance Analysis
WeekdayDoc's proprietary algorithm rates Physician Reviewer Dentist or Orthodontist - Licensed in Indiana at Federal Hearings And Appeals a 8.2 out of 10 for work-life balance — classified as excellent. This places the position in the top 5% in Dentist — ranked against 3,154 active Dentist listings on WeekdayDoc. Contributing factors include remote work flexibility.