Anticipated End Date:

2025-02-07

Position Title:

Physical Therapist Reviewer

Job Description:

Physical Therapist Reviewer

Work schedule: M-F 7:30am to 4:30pm EST.

Location: Fort Wayne Indiana

***This position is virtual but requires fieldwork. You may work from your home office when not in the field. The individual is required to live in the area noted above as that is the territory/market that they will work in.

The Physical Therapist Reviewer is responsible for performing medical record reviews specific to services billed related to physical therapy with adherence to all contract requirements, ISO processes and operational unit goals to ensure customer satisfaction. This position is specifically dedicated to serve the members well-being through preventative care, immediate consultation, and appropriate referrals.

How you will make an impact:

Conducts medical review/claim review of beneficiary health records specific to therapy services in support of investigations, cases, law enforcement requests and other activities.

Documents findings, develops, analyses and submits necessary reports to the appropriate departments in accordance with regulations and requirements.

Codes and prices complex claims using ICD-9, HCPCS and CPT manuals and coding guidelines when necessary as it relates to therapy services.

Researches and obtains additional data, when necessary.

Acts as a resource for internal and external customers.

Maintains productivity standards and ensures reviews are conducted within required timeframes.

Develops and delivers educational programs and presentations.

Recommends or guides adjustments to therapy treatment plans as necessary.

May provide one-on-one consultations with members to address musculoskeletal concerns.

Minimum Requirements:

Requires BA/BS in physical therapy and minimum of 3 years clinical experience; or any combination of education and experience, which would provide an equivalent background.

Current licensed physical therapist in applicable state required.

Preferred Capabilities, Skills and Experiences:

Master’s or Doctorate degree in physical therapy

Life and Health License

Clinical experience in musculoskeletal health, rehabilitation, assessment, and treatment.

Proficiency with electronic health record systems.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

MED > Licensed/Certified Allied Health Professional

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.