Federal Hearings And Appeals·Wilkes-Barre, Pennsylvania
Responsible for reviewing medical case files and making medical determinations. Reviews and analyzes Federal and State laws, regulations, and applicable policy guides.
Physician Peer Reviewer –
Federal Hearings and Appeals Services (FHAS) is a URAC-accredited Independent Medical Review Organization (IRO) with Health Utilization Management (HUM) accreditation. For the past 30 years, FHAS has provided external peer review services to healthcare organizations, government agencies, insurance companies, and legal entities.
FHAS is currently expanding its elite panel of physicians licensed to assist with independent review claims and appeals in any of the following specialties:
Addiction Medicine, Allergy & Immunology, Anesthesiology, Cardiovascular Disease, Child & Adolescent Psychiatry, Chiropractic Medicine, Dentist, Dermatology, Emergency Medicine, Endocrinology, Diabetes, & Metabolism, Family Medicine, Gastroenterology, Internal Medicine, Interventional Cardiology, Interventional Radiology & Diagnostic Radiology, Medical Genetics & Genomics, Medical Oncology, Nephrology, Neurological Surgery, Neurology, Obstetrics and Gynecology, Ophthalmology, Orthopedic Surgery, Pain Medicine, Pathology, Pediatrics, Pediatric Cardiology, Pediatric Critical Care Medicine, Developmental-Behavioral Pediatrics, Pediatric Emergency Medicine, Pediatric Gastroenterology, Pediatric Nephrology, Physical Medicine & Rehabilitation, Plastic Surgery, Psychiatry, Psychology *PhD, Radiation Oncology, Radiology, Rheumatology, Sleep Medicine, Thoracic & Cardiac Surgery, Transplant Hepatology, Undersea & Hyperbaric Medicine
Description
Responsible for reviewing medical case files and making medical determinations. Cases may include medical necessity and medical appropriateness, experimental or investigational treatment, administrative or legal issues, or a combination of these categories, which are filed with the Department of Human Services’ Bureau of Hearings and Appeals (BHA).
Reviews and analyzes Federal and State laws, regulations, and applicable policy guides
Completes and evaluates the review process in a regulatory timeframe.
Work Experience Requirements
Successful completion of a Residency or Fellowship Program
Must possess a current state license in a state of the United States/recognized in the relevant jurisdictions as a Doctor of Medicine or Doctor of Osteopathic Medicine and if required by contract, licensed in the state in which requests the review.
License is unrestricted and if there is a restriction that is allowed by a relevant jurisdiction, according to the medical director or clinical director, it is of the type that does not affect the health professional’s ability to fulfill the roles and responsibilities of a reviewer.
License is of the type and scope that permits applying clinical judgement in consideration of an individual members clinical needs to render a decision.
For either a Doctor of Medicine or Doctor of Osteopathic Medicine, possess the same license or certification as the ordering practitioner.
Must hold a current board certification issued by the American Board of Medical Specialties or American Osteopathic Association.
5-years or more post graduate active clinical experience in direct patient care
Experience providing direct patient care within the past 3 years, if performing external reviews
Candidates must have completed a Residency or Fellowship Program and possess a current state license as a Doctor of Medicine or Doctor of Osteopathic Medicine. Additionally, they must hold board certification and have at least 5 years of post-graduate clinical experience.
Market context
In Pennsylvania, physician peer reviewer roles for dermatology typically attract experienced clinicians who can evaluate cases with strong clinical judgment and documentation skills. This role is competitive because it requires residency or fellowship training, an active Pennsylvania MD or DO license, board certification, and at least 5 years of post-graduate clinical experience. Before applying, confirm your licensure, board status, and review experience, and note that the job requirements and benefits shown here are AI-summarized from the original job description to save research time.
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