• Job Description

  Req#: 19620

  A Physician Reviewer is a medical professional responsible for evaluating and analyzing medical records, treatment plans, and healthcare claims to ensure they adhere to established medical guidelines and standards. As a Physician Reviewer, you will be responsible for analyzing medical records, applying ICD-9-CM and ICD-10-CM coding guidance, and conducting quality assurance activities. Your expertise in medical coding, knowledge of the Medicare Advantage program, and experience in medical record review quality assurance will be crucial for ensuring accurate and compliant data abstraction. A background in program integrity/fraud, waste, and abuse is strongly preferred.

  Compensation & Benefits:

  Estimated Starting Salary Range for Physician Reviewer: Pay commensurate with experience. Highly competitive compensation.

  Physician Reviewer Responsibilities Include:

  • Review and interpret complex medical documentation to identify and extract pertinent clinical information.
  • Inform diagnoses abstraction activities by providing a clinical basis for rendering specific diagnoses after analyzing medical records. Analyze medical records to abstract diagnoses using ICD-9-CM and ICD-10-CM coding guidance.
  • Ensure accurate and consistent application of coding guidelines to abstract medical diagnoses from a variety of medical records
  • Support the quality assurance activities for medical record intake, medical record code abstraction, and appeals support.
  • Collaborate with interdisciplinary teams to ensure comprehensive and accurate medical record abstraction.
  • Stay updated on the latest coding guidelines and regulations, including changes in ICD-9-CM and ICD-10-CM codes and guidelines.
  • Apply knowledge of the Medicare Advantage program and related data or records to identify and address coding and documentation issues.
  • Participate in quality assurance activities to assess the accuracy and completeness of medical record abstractions.
  • Conduct medical record review quality assurance activities, including sample selection, record analysis, and reporting findings to support ongoing improvement efforts.
  • Assist in the development and implementation of coding education and training programs for healthcare providers to improve documentation and coding accuracy.
  • Collaborate with internal and external stakeholders to address coding-related queries, resolve issues, and provide guidance on coding and documentation requirements.
  • Performs other job-related duties as assigned.

  Physician Reviewer Experience, Education, Skills, Abilities requested:

  • The Physician Reviewer(s) must be a board-certified Doctor of Medicine or a Doctor of Osteopathy in a specialty recognized by the American Board of Medical Specialties.
  • The Physician Reviewer(s) must have been board certified for at least three (3) years.
  • The Physician Reviewer(s) must have an active, valid and unrestricted license and must be currently licensed to practice in at least one US state.
  • Experience in the health insurance industry, a utilization review firm, or health care claims processing organization.
  • In-depth knowledge of ICD-9-CM and ICD-10-CM coding guidelines and the ability to apply them accurately and consistently.
  • Active, valid, and unrestricted license and currently licensed to practice in at least one US state.
  • Familiarity with the Medicare Advantage program and its related data or records.
  • Experience with quality assurance activities, particularly in medical record review quality assurance, is preferred.
  • Strong analytical skills with the ability to review and interpret complex medical documentation.
  • Excellent attention to detail and the ability to work with a high level of accuracy.
  • Proficient in using coding software and electronic health record systems.
  • Strong communication and interpersonal skills to collaborate effectively with diverse healthcare professionals and stakeholders.
  • Ability to work independently, manage multiple tasks, and meet deadlines in a fast-paced environment.
  • Must pass pre-employment qualifications of Cherokee Federal.

  Company Information:

  Cherokee Federal Strategic Programs (CNSP) provides support, services, and solutions to federal and commercial customers. The company takes a personalized approach to solving our clients' toughest challenges, helping you make the most of your skills. CNSP is part of Cherokee Federal – a team of tribally owned federal contracting companies. For more information, visit cherokee-federal.com.

  #CherokeeFederal #LI #LI-Remote

  List 5 similar job titles:

  • Medical Review Physician
  • Clinical Reviewer
  • Utilization Review Physician
  • Medical Claims Reviewer
  • Physician Auditor

  List 5 keywords:

  • Physician Review
  • Medical records
  • Healthcare claims
  • Medical guidelines
  • Quality assurance

  Please Note: This position is pending a contract award.

  If you are interested in a future with Cherokee Federal, APPLY TODAY! Although this is not an approved position, we are accepting applications for this future and anticipated need.

  Legal Disclaimer: Cherokee Federal is an equal opportunity employer. Please visit cherokee-federal.com/careers for information regarding our Affirmative Action and Equal Opportunity Employer Statement, Accommodation request, and Presidential EO 14042 Notice.

• About the company

  Cherokee Federal is a team of tribally owned federal contracting companies serving more than 60 federal clients around the globe.

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