Licensed Physician Claims Reviewer

Job Summary

A company is looking for a Physician ED Claims Reviewer.

Key Responsibilities

• Conduct utilization management authorizations and claims adjudication to assess medical necessity
• Review and validate claims in accordance with medical coding standards and payer policies
• Manage high-volume cases independently while ensuring accuracy and compliance with regulations

Required Qualifications

• US licensed Physician with 3-5 years of recent clinical experience, particularly in Emergency Department medicine
• Experience in managed care clinical review and utilization management
• Strong knowledge of medical coding standards (CPT/HCPCS)
• Ability to work independently in a fast-paced environment
• Proficient in using multiple clinical systems and applications