Claims Review Diagnostic Radiologist

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 seeking an experienced 1099 Claims Review Diagnostic Radiologist . This role is crucial for the fair and efficient resolution of claim disputes.

Responsibilities include resolving claim disputes submitted by physicians, hospitals, institutions, pharmacies, and other healthcare providers, as well as assisting both contracted and non-contracted providers and healthcare plans. The role requires conducting duties efficiently, promptly, productively, consistently, and courteously, maintaining 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 or procedures in dispute. Use 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 directed by leadership.

Required Qualifications: Licensed in the required specialty. At least five years of full-time clinical care experience. Recent clinical care experience within the past three years.

Hold a non-restricted US license and, for physicians, current certification by a recognized American medical specialty board. Preferred Qualifications: Familiarity with claims and claim review processes. Experience navigating electronic documents (PDFs, MS Excel, Word, Outlook).

Ability to manage sensitive information, organize effectively, and communicate clearly in English. Ability to work independently and collaboratively. Skilled in prioritizing tasks according to business needs.

Required Screenings: Background check required; employment contingent on passing. Reasonable Accommodation: Applicants requiring alternative application or screening methods should contact the employer directly. Reasonable 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 discrimination based on race, color, religion, sex, age, disability, sexual orientation, gender identity, or other protected statuses. Texting Notice: Applicants may be contacted via text, email, or phone.

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