Board Certified Orthopedic Surgeon - Workers' Compensation File Review, Independent Contractor

Job Description

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 Carolina’s 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 You’ll 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 worker’s compensation cases.

Our requirements for this role :

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.