Physician Consultant

About the Role

Copper River Strategies is seeking a Physician Consultant to provide clinical expertise and medical oversight in support of healthcare insurance operations. The Physician Consultant will resolve complex medical record issues, interpret clinical documentation, support intake, coding, quality assurance, and appeals activities. This position requires an actively practicing, board-certified physician with experience in health insurance, utilization review, or claims and a strong understanding of Medicare program requirements and clinical guideline interpretation.

This position is primarily remote; however, onsite presence at the Center for Medicare & Medicaid Services (CMS) in Baltimore, Maryland, may be required on an as-needed basis to support program requirements, stakeholder meetings, and other business needs.

Responsibilities

• Provide clinical expertise in the review and interpretation of complex medical records.
• Resolve complex clinical documentation and medical record issues.
• Interpret clinical documentation in accordance with applicable medical guidelines and program requirements.
• Support intake and clinical review processes.
• Provide clinical guidance supporting coding accuracy and consistency.
• Support quality assurance activities and clinical quality reviews.
• Assist with the review and resolution of medical appeals.
• Apply clinical judgment to complex cases requiring physician-level expertise.
• Interpret Medicare program requirements and applicable clinical guidelines.
• Collaborate with clinical, operational, coding, quality assurance, and appeals teams.
• Provide recommendations regarding complex medical and clinical issues.
• Support continuous improvement of clinical review and healthcare insurance processes.

Essential Job Qualifications and Requirements

Education and License

• Board certified for a minimum of three (3) years in an American Board of Medical Specialties (ABMS)-recognized specialty
• Medical degree from an accredited medical school required
• Active, valid, unrestricted U.S. medical license required

Required Experience

• Actively practicing physician with a minimum of three (3) years of clinical practice experience
• Experience in health insurance, utilization review, or claims

Demonstrated Knowledge & Skills

• Knowledge of the Medicare program
• Demonstrated ability to interpret and apply clinical guidelines
• Strong analytical, clinical judgment, and communication skills
• Clinical evaluation and medical record interpretation
• Clinical documentation interpretation
• Coding review and clinical coding support
• Quality assurance and clinical quality review
• Appeals and complex case resolution
• Medicare program requirements
• Interpretation and application of clinical guidelines

About Copper River & The Native Village of Eyak

Owned by the Native Village of Eyak (NVE), a federally recognized Alaska Native Tribe, the Copper River Family of Companies are a collection of entities that deliver a complementary set of solutions and services to support the diverse missions and requirements of our clients. Proud participants of the Small Business Administration’s (SBA) 8(a) Business Development Program since 2006, our companies consist of both current and graduation SBA 8(a) entities. It is our collective purpose to support the Tribe and diversify the NVE’s ability to facilitate economic advancement.

The income generated from our companies helps the Native Village of Eyak fund health and social services, economic development, natural resource/environmental education, jobs, job training, and other benefits to the NVE in a manner that is consistent with Alaskan Native cultural values and traditions.

Copper River’s Culture

The Copper River Family of Companies has a positive, supportive, and thriving culture. At the foundation of our culture is a focus on collaboration. No matter your role or which operating company you work for, we are ONE TEAM working toward the same goals for our customers and for our collective owner- The Native Village of Eyak. How we treat each other is just as important as the work we deliver.

Benefits

• Comprehensive medical, dental, and vision coverage
• Flexible Spending Account - healthcare and dependent care
• Health Savings Account - high deductible medical plan
• Retirement 401(k) with employer match
• Open leave policy and paid holidays
• Additional benefits including tuition reimbursement, transportation expense account, employee assistance program, and more!

Note : These benefits are only applicable to full time, regular associates at Copper River.