Contract Physician – Medical Necessity Review (Genetic Testing)
Artificial IntelligenceArtificial IntelligenceContractRemote
Location
United States
Posted
20 days ago
Salary
Not specified
No structured requirement data.
Job Description
This role involves supporting asynchronous medical necessity review following a completed genetic counseling session. Services rendered under this role will support claims submitted to federal payers.
Review clinical documentation completed by a Genetic Counselor following patient history intake and pre-test counseling.
Assess and determine medical necessity for genetic testing.
Review and authorize testing orders & sign required supporting documents, when deemed appropriate.
Ensure compliance with state regulations, payer requirements, and internal clinical protocols.
Maintain HIPAA compliance and documentation standards.
Job Requirements
- Active, unrestricted medical license in good standing. License in Kansas or Arkansas (along with residence in KS or AR) prioritized.
- Medicare enrollment required. Enrollment in Kansas or Arkansas Medicaid preferred, or willingness to enroll with administrative support.
- Board Certified in primary care specialty (Internal Medicine, Family Medicine, Pediatrics, or other relevant specialty).
- Ability to independently evaluate clinical documentation and render medical necessity determinations.
- Comfortable working in a fully asynchronous, technology-enabled workflow.
- Strong attention to detail and documentation accuracy.
- Telehealth or virtual care experience preferred.
- Prior experience with genetic testing.
- Familiarity with payer medical necessity criteria.
- Experience working with Medicaid populations.
Benefits
- Fixed payment per review.
- Flexible schedule.
- 100% Remote.
- Professional Liability Insurance.
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