About the Company - The Part C QIC program is responsible for rendering decisions on 2nd-level Medicare Advantage appeals. We serve as the Independent Review Entity for Medicare Part C, meaning that we work for Medicare. Our main role is to review Medicare Part C appeals to determine if a Medicare Health Plan's denial of an item or service is appropriate. Many of these cases involve issues of Medical Necessity which require a physician's review. This review is then incorporated into a decision letter that is disseminated to all parties to the appeal.
About the Role - Common medical necessity issues are: continued stay in a Skilled Nursing facility; medical appropriateness of drugs, medical appropriateness of diagnostic imaging, etc.
Responsibilities - Minimum Qualifications:
• Clean Active License
• Board Certification
• 5 years experience in appropriate specialty post training (MD/DO)
• The project team will provide training once provider has completed Maximus
• Onboarding process.
Pay range and compensation package - Qualified Independent Contractor Medicare Part C Standard Case Reviews will have Due Date Specified- $ 65/review 30 mins to complete Expedited Review (Physicians)- $ 90/review 30 mins to complete
*Written Reviews take approximately 25-30 minutes to complete Anticipated volume 300 reviews per month (10-15 hrs/wks), one provider is highly desired for all reviews.
If you have any questions, please feel free to reach out at your convenience.
Thank you for your support, we look forward to working with you!