Physical Therapist ReviewerWork schedule: M-F 7:30am to 4:30pm EST.Location: Fort Wayne Indiana***This position is virtual but requires fieldwork 3-4 days per week. You may work from your home office when not in the field. The individual is required to live in the area noted above as that is the territory/market that they will work in.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.How you will make an impact: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.Minimum 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.Preferred Capabilities, Skills and Experiences:Master’s or Doctorate degree in physical therapyLife and Health LicenseClinical experience in musculoskeletal health, rehabilitation, assessment, and treatment.Proficiency with electronic health record systems.
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