Urology Physician (, TX, United States)

Urology Physician at Dane Street

Summary: The Urology Physician engages in telework, offering flexible scheduling while assessing insurance appeals and claims related to urology. They utilize clinical expertise to review medical records, ensuring compliance with guidelines and standards of care, and provide clear documentation for decisions made. As independent contractors, they must maintain their credentials and respond promptly to case reviews, ensuring high-quality evaluations.

This telework opportunity allows you to customize your schedule and caseload within the week while maintaining client-mandated turnaround times. Our reviewers are compensated on a per-case basis as a 1099 independent contractor.

Requirements: Candidates must hold an active Texas License.

Job Summary: Utilizes clinical expertise to review insurance appeals and claims, providing interpretation of the medical necessity of services in compliance with client policies, evidence-based guidelines, and standards of care.

Major Duties and Responsibilities:

1. Contractor status with Dane Street.
2. Review all medical records and address client questions using specific criteria or recognized evidence-based guidelines.
3. Ensure clear, concise rationale with supporting documentation for decisions.
4. Utilize current criteria, guidelines, and literature to support objective decision-making; avoid limited sample size case studies.
5. Provide copies of criteria used in reviews promptly.
6. Make mandated calls, including Peer to Peer calls if required.
7. Review cases efficiently, typically within 15-30 minutes per case.
8. Prepare cases in advance for review.
9. Some cases may require same-day review to meet turnaround times.
10. Return cases on or before due dates.
11. Maintain proper credentials, licenses, and certifications.
12. Attend all required training and orientation.
13. Perform additional duties such as responding to QA issues, complaints, audits, or court appearances.

Note: Dane Street will never conduct interviews via text or request checks for equipment purchases.

Keywords: Urology, Telework, Independent Contractor, Insurance Appeals, Medical Review, Healthcare, Clinical Expertise, Case Review, Medical Necessity, Credentialing