Step by Step Guide on How to Become an ‘Independent Physician Reviewer’.

Introduction

Becoming an independent physician reviewer as a full-time surgeon partially found me and partly became a specific goal of mine.

An independent physician reviewer is a fully licensed board-certified clinically active (>20 hours/week for most ) physician who reviews charts for the following reasons: disability claims, pre-authorization for procedures or medications, insurance denials post-intervention/treatment, inpatient hospital utilization reviews, and insurance denials for various covered services, (including but not limited to hospital transfers, emergency transportation, out-of-network services).

You get paid for your work either hourly or per review, but most companies will pay you hourly. Most companies will set an hourly rate based on your board certifications.

You can choose to do the reviews as you are available, including the urgency of the review and the availability to do a peer-to-peer.

You will get taxed on a 1099 form at the end of the fiscal year. You will get paid via check or direct deposit. If you have enough income consider starting an LLC.

I started my journey as an independent physician reviewer unexpectedly. I signed my contract for my first full-time job after two fellowships and residency unexpectedly, became pregnant, started working 5 months after my training, and then gave birth.

I applied for short term disability 10 days postpartum, which was denied because of my “pre-existing condition” of pregnancy.

As the breadwinner of my family, I was not financially prepared to have no income for 6 weeks.

So, I sought other sources of income and that is how I became an independent reviewer.

Here is my Step by Step Guide:

1)  Update your CV.

2)  Update and maintain your LinkedIn profile in detail, indicating you are looking for work.

3)  Have one or two trusted physician references on hand just in case (only a few have asked).

4)  Update your CAQH Proview profile. CAQH is a commonly used credentialing database.

5)  Save electronic PDFs of the following: Board certifications, Medical school, Graduate school, and Undergraduate diplomas, Drivers’ License, State licenses, and DEA license. You may want to keep your medical malpractice document, although this is not necessary to perform these reviews since the work is nonclinical. Maintain all PDFs on Dropbox or other cloud base storage for easy access. (I use the ScannerPro app on my phone).

6)  Visit NAIRO.org (National Association of Independent Review Organizations) and note all the members.

7)  In the above link, Click on each member’s website to go to the websites of the NAIRO members, click on “Careers” or “Contact Us”. Look for “Become one of our physician reviewers” or “Join our panel”. If your specialty isn’t listed as being available, contact them anyway, as often times the position will not be posted.

8)  Apply via the job posting, or use their web-based contact form indicating you are interested in becoming an independent physician reviewer.

9)  Check your email and LinkedIn messages.

10) While you are waiting, consider educating yourself through MCG, ABQAURP, volunteering on your hospital’s utilization review/CDI/Quality committee, and joining the Facebook group for Physician Advisors, Chart Review, CDI, and Utilization Management.

11) Keep a written or web-based list of all the companies’ websites, your username and sign in (as you get busy, you will forget them all!).

Conclusion:

Working as a physician reviewer provides education beyond the scope of a physician’s medical education and typical clinical practice.

You can choose to be as busy as you want and work around your clinical duties.

You can often do these reviews between patients, on lighter clinical days, at night or the weekends, or between cases if you are a surgeon.

My experience as an independent reviewer, while creating a little extra income, has been a springboard for my improvement as a busy clinician.

Haane Massarotti, MD FACS FASCRS

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