Physician Consultant
$160,000–$220,000 year
HybridBaltimore, Maryland, United States
Job Summary
Review and interpret complex medical records to resolve clinical documentation issues and support intake, coding, and quality assurance activities. Provide clinical guidance for appeals resolution, coding accuracy, and Medicare program compliance while collaborating with operational and clinical teams. Apply physician-level expertise to complex cases requiring clinical judgment and guideline interpretation. This role is primarily remote with potential on-site presence at CMS in Baltimore, Maryland, for stakeholder meetings and program requirements. The position supports continuous improvement of healthcare insurance processes within a collaborative team environment.
Required Qualifications
- Actively practicing, board-certified physician
- Experience in health insurance, utilization review, or claims
- Strong understanding of Medicare program requirements and clinical guideline interpretation
- Board certified for a minimum of three (3) years in an American Board of Medical Specialties (ABMS)-recognized specialty
- Medical degree from an accredited medical school
- Active, valid, unrestricted U.S. medical license
- Actively practicing physician with a minimum of three (3) years of clinical practice experience
- Knowledge of the Medicare program
- Demonstrated ability to interpret and apply clinical guidelines
- Strong analytical, clinical judgment, and communication skills
- Clinical evaluation and medical record interpretation
- Clinical documentation interpretation
- Coding review and clinical coding support
- Quality assurance and clinical quality review
- Appeals and complex case resolution
- Medicare program requirements
- Interpretation and application of clinical guidelines
- Onsite presence at the Center for Medicare & Medicaid Services (CMS) in Baltimore, Maryland, may be required on an as-needed basis
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