Board Certified Orthopedic Surgeon � Workers� Compensation File Review, Independent Contractor
Board Certified Orthopedic Surgeon � Workers� Compensation File Review, Independent Contractor
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Job Description
Board Certified Orthopedic Surgeon Workers Compensation File Review
Remote Independent Contractor
Who We Are:
Constellation Quality Health is a non-profit health care quality consultancy and QIO-like Entity certified by Centers for Medicare and Medicaid Services (CMS) founded by physicians in 1983. Headquartered in North Carolinas Research Triangle we offer an array of quality improvement clinical review audit technical and consulting services and solutions to improve care delivery system performance and patient outcomes.
What Youll Do:
Constellation Quality Health seeks a Board-Certified Orthopedic Surgeon (M.D.) with at least three years of experience reviewing workers compensation claim files to support our healthcare fraud waste and abuse (FWA) detection efforts. In this independent consultant role you will review medical documentation to assess the appropriateness of care validate billing practices and identify patterns of overutilization upcoding or non-medically necessary services.
We expect you to:
- Conduct detailed reviews of workers compensation medical records operative reports and billing files.
- Assess consistency between diagnosis procedures and clinical documentation.
- Identify potential FWA indicators related to orthopedic care (e.g. excessive imaging unnecessary surgeries prolonged disability timelines).
- Provide written summaries and expert opinions based on medical evidence and accepted clinical standards.
- Collaborate with clinical and investigative teams to support case development and legal proceedings as needed.
This position is contingent upon contract award.
Who You Are:
Successful candidates will have prior experience working with Special Investigation Units (SIUs) insurance carriers or government programs (e.g. Medicaid Medicare) familiarity with CPT/ICD coding and billing practices and experience serving as an expert witness or providing deposition testimony in workers compensation cases.
Our requirements for this role:
- Medical Doctor (M.D.) with Board Certification in Orthopedic Surgery.
- Active and unrestricted medical license in the United States.
- Minimum of 3 years experience reviewing workers compensation claims or performing peer reviews/IMEs with a focus on fraud waste and abuse.
- Strong understanding of evidence-based orthopedic care clinical guidelines and utilization review standards.
- Excellent written and verbal communication skills.
- Experience with providing expert witness or deposition testimony.
Why Constellation Quality Health
We offer a competitive salary and a flexible work environment.
Equal opportunity employer of protected veterans
Equal opportunity employer of individuals with disabilities
We do not discriminate on the basis of race ancestry color religion sex age marital status sexual orientation gender identity national origin medical condition disability veteran status or any other basis protected by law.
Applicants and employees are protected from discrimination based on inquiring about disclosing or discussing compensation or the compensation of other applicants or employees.
Required Experience:
Contract
Employment Type
Contract
