Physician Reviewer

ABOUT PERFORMANT:

At Performant, we're focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most - quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture - then Performant is the place for you!

ABOUT THE OPPORTUNITY:

Agency submissions are not being accepted at this time. We are seeking independent contractors who must have a MD or DO medical license and will work on a 1099 basis. Interested Physicians who already have an LLC set-up for billing purposes are preferred, though not necessarily required.

Contractor Assignment Summary:

The Physician Reviewer (contractor) provides expert clinical review and oversight for medical audits, ensuring compliance with governing policies and accuracy in claim determinations. This role involves reviewing Medical Review Instruments (MRIs), validating audit results, supporting appeals, and participating in peer-to-peer discussions with providers and regulatory agencies.

Please note, this is a Contractor/Temporary Worker position and does not have benefits eligibility.

Compensation is commensurate with the work being completed. Varying hourly rates are offered for claim reviews, MRI development, and appeals/consulting.

Compensation will be discussed further during initial interview.

This assignment will carry a 100-200 hour commitment each month and is dependent on number and type of cases assigned.

Key Responsibilities to include:

Medical Review Instrument (MRI) Review

• Review client's draft MRI, which defines the stepwise approach to claim audits and controlling policies.
• Provide expert feedback on scope and specialized details to perfect the MRI.
• Incorporate follow-up feedback after HHS OIG consultation within 30 days of initial review.
• Complete reviews within agreed turnaround times.

Peer Reviews

• Access medical records and Review Results Letters (RRLs) in the client's secure environment.
• Confirm that RRLs accurately apply MRI guidelines and provide clear rationale for compliance or non-compliance.
• Suggest corrections, enhancements, and improvements to drafted rationale text.
• Participate in quality assurance reviews and incorporate feedback from Client and HHS OIG.
• Complete reviews based on complexity and turnaround times:
• Moderate Complexity: Single claims, short service duration, no longitudinal analysis.
• High Complexity: Multiple claims, extended service duration, or case-based reviews (e.g., Home Health, SNF, IRF).

Appeals Preparation

• Analyze provider responses following OIG audits.
• Assess relevance and accuracy of feedback against RRLs and medical records.
• Draft analysis and support at least two consultation calls with Client.
• Additional rounds of feedback and consultation are treated as new service incidences.

Peer-to-Peer Participation

• Participate in discussions with Client, OIG, and providers to clarify audit findings.
• Provide expert input during meetings, which may include multiple sessions.

Compliance and Workplan

• Commit to agreed workplans and timelines for initial and follow-up reviews.
• Ensure adherence to turnaround standards and quality expectations.
• Maintain compliance with privacy and security regulations, including handling of PHI.

Travel

• Attend industry-related meetings or appeals work as required by OIG/HHS.
• Travel reimbursed per client policy; coach seating and approved expenses only.

Knowledge, Skills and Abilities Needed:

• Demonstrated familiarity with audit processes, appeals, and peer-to-peer provider engagement.
• Ability to interpret complex medical records and apply regulatory guidelines consistently.
• Collaborative mindset and adaptability to dynamic work environments.

• Consistently delivers on promises and deadlines.
• Willing and able to work cross functionally when necessary.
• Demonstrated ability to consistently apply sound judgment and good effective decision making.
• Excellent communication skills, both verbal and written; ability to communicate effectively and professionally.
• Excellent time management and delivers results balancing multiple priorities.
• Strong analytical skills; synthesizes complex or diverse information; collects and researches data; uses experience to compliment data.
• Strong general technical skills, including, but not limited to Desktop and MS Office applications.
• Solid technical aptitude with demonstrated ability to quickly learn and adapt to new systems and tools.
• Ability to work independently in remote setting with minimum supervision and direction in the form of objectives.
  

Required Qualifications:

• MD or DO, board-certified and licensed to practice medicine, are all required.
• No prior sanctions or exclusions from Medicare or Medicaid programs.
• Strong knowledge of Medicare, Medicaid, and payer policies.
• Experience in medical auditing, compliance, and clinical review.
• Excellent analytical, documentation, and communication skills.
• Ability to work within strict timelines and secure environments.

WHAT WE OFFER:

Performant offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually. For more information about our benefits package, please refer to our benefits page on our website or ask your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.

• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).

• Regularly sit/stand 8 or more hours per day.

• Occasionally lift/carry/push/pull up to 10lbs.

Performant is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Performant Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Performant's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Performant is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Performant will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Performant's Human Resources team to discuss further.

Our diversity makes Performant unique and strengthens us as an organization to help us better serve our clients. Performant is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED