Claims Review Pain Management/Anesthesiologist

17 hours ago

Isabela, Autonomous Region in Muslim Mindanao, Philippines CapitolBridge Full time $250,000 per year

About Capitol BridgeFounded in 2012, Capitol Bridge is based in Arlington, Virginia, and specializes in providing independent medical reviews, records/data management services, medical coding, administrative staffing, and eligibility reviews. Capitol Bridge is actively seeking an experienced 1099 Claims Review Pain Management/Anesthesiologist. This Claims Review position is vital for the fair and efficient resolution of claim disputes.

You will be responsible for resolving claim disputes submitted by physicians, hospitals, institutions, pharmacies, and other licensed healthcare providers. Additionally, you will assist both contracted and non-contracted healthcare providers and plans in resolving claims disputes. The role requires conducting duties efficiently, promptly, productively, consistently, and courteously, maintaining a high level of professionalism.

Salary Range: Approximately $250 per case, depending on case requirements. Key Responsibilities:Conduct impartial assessments of documentation from all parties involved. Review medical documentation to determine the medical necessity or appropriateness of services/procedures in dispute.

Utilize governmental and professional guidelines to support determinations. Adhere to company policies, state regulations, and project guidelines. Maintain effective communication with stakeholders.

Ensure reviews are completed within deadlines. Follow QA/QC processes and meet departmental standards. Uphold scheduling commitments and privacy regulations.

Perform other duties as assigned by leadership. Required Qualifications:Licensed in the required specialty. Five years of full-time clinical care experience.

Experience providing clinical care within the past three years. Hold a non-restricted license in any US state; physicians must have current certification by a recognized American medical specialty board. Preferred Qualifications:Familiarity with claims and review processes.

Experience navigating electronic documents (PDFs), Microsoft Excel, Word, and Outlook. Exceptional skills in managing sensitive information. Strong organizational, written, and verbal communication skills in English.

Ability to work independently and collaboratively. Skilled in prioritizing tasks. Required Screenings:A background check is required; employment is contingent upon passing.

Reasonable Accommodation:Applicants requiring alternative application or screening methods should contact the employer directly. Reasonable accommodations may be made for individuals with disabilities to perform essential duties. EEO Statement:Capitol Bridge LLC is an Equal Opportunity Employer.

Employment decisions are based on qualifications and business needs, without discrimination based on race, color, religion, sex, age, disability, or other protected statuses. Texting Notice:We may contact applicants via text in addition to email and phone. You may opt-out of text communications at any time.

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