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Therapist Reviewer

Mindlance Inc
Grand Prairie, Texas, United States
November 07, 2016


Responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) were medically necessary and filed appropriately. Primary duties may include, but are not limited to: Applies professional therapy, government regulation, and medical policy knowledge to medical review, and makes determinations for authorization requests, meeting all contract requirements, processes and operational unit goals to ensure customer satisfaction. Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements. Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary. Acts as a resource for internal and external customers. May participate in intradepartmental teams, projects and initiatives. Maintains quality and productivity standards, and ensures reviews are conducted within required timeframes. Requires a graduate of a college level program in physical therapy, occupational therapy, or speech language pathology or an accredited two year program for a Physical Therapist Assistant, Occupational Therapist Assistant, or Speech Language Pathologist Assistant; 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current active unrestricted license or certification as a physical therapist assistant, occupational therapist assistant, or speech language pathologist assistant in applicable state required. Certification and/or licensure appropriate to field of specialty as required.