Claims Review Neurologist

About Capitol BridgeFounded in 2012, Capitol Bridge is based in Arlington, Virginia, with expertise 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 Neurologist. The Claims Review position plays a crucial role in the fair and efficient resolution of claim disputes.

You will be responsible for resolving claim disputes submitted by various parties, including physicians, hospitals, institutions, pharmacies, and other licensed healthcare providers. Additionally, you will assist both contracted and non-contracted healthcare providers and health plans in resolving claims disputes. Your duties require efficiency, promptness, productivity, consistency, courtesy, and professionalism.

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

Utilize governmental and professional guidelines to support determinations regarding medical necessity or appropriateness. Adhere to company policies, state regulations, and project-specific guidelines. Maintain effective communication with all parties involved.

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

Perform other duties as directed 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; for physicians, current certification by a recognized American medical specialty board in relevant areas. Preferred Qualifications:Familiarity with claims and claim review processes.

Experience navigating electronic documents (PDFs, Microsoft Office Suite, Outlook). Ability to manage sensitive and confidential information. Strong organizational, written, and verbal communication skills in English.

Ability to work independently and collaboratively. Skilled in prioritizing tasks to meet business needs. Additional Information:Screenings: Background checks are required and employment is contingent on passing.

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

Employment decisions are based on business needs, job requirements, and individual qualifications, without regard to protected statuses. Texting Notice: We may contact applicants via text regarding this position or application status. You may opt-out of text communications at any time.