Physical Therapist Reviewer

Elevance Health

248d

About The Position

The Physical Therapist Reviewer is responsible for performing medical record reviews specific to services billed related to physical therapy with adherence to all contract requirements, ISO processes and operational unit goals to ensure customer satisfaction. This position is specifically dedicated to serve the members well-being through preventative care, immediate consultation, and appropriate referrals. The position is virtual but requires fieldwork 3-4 days per week, and the individual is required to live in the specified area as that is the territory/market they will work in.

Requirements

• Requires BA/BS in physical therapy and minimum of 3 years clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current licensed physical therapist in applicable state required.

Nice To Haves

• Master's or Doctorate degree in physical therapy
• Life and Health License
• Clinical experience in musculoskeletal health, rehabilitation, assessment, and treatment.
• Proficiency with electronic health record systems.

Responsibilities

• Conducts medical review/claim review of beneficiary health records specific to therapy services in support of investigations, cases, law enforcement requests and other activities.
• Documents findings, develops, analyses and submits necessary reports to the appropriate departments in accordance with regulations and requirements.
• Codes and prices complex claims using ICD-9, HCPCS and CPT manuals and coding guidelines when necessary as it relates to therapy services.
• Researches and obtains additional data, when necessary.
• Acts as a resource for internal and external customers.
• Maintains productivity standards and ensures reviews are conducted within required timeframes.
• Develops and delivers educational programs and presentations.
• Recommends or guides adjustments to therapy treatment plans as necessary.
• May provide one-on-one consultations with members to address musculoskeletal concerns.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical, dental, vision benefits
• Short and long term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree