Utilization Review Chiropractor – Jessica Allen

Today’s non-clinical spotlight focuses spotlight focuses on Jessica Allen, who created a really cool non-traditional career as a utilization review chiropractor.

What is your full name and title at your current job?

Jessica Allen, DC
Utilization Review Chiropractor

I’m contracted with several independent review organizations (IROs). Some call me a peer reviewer, and some call me a physician advisor.

[Editor’s note: For consistency’s sake, I am using the title “Utilization Review Chiropractor,” but a rose by any other name… ;)]

Where did you go to DC school, and what year did you graduate?

Northwestern Health Sciences University, 2010

What did you do when you first finished school, and for how long?

I initially worked as an associate in a busy family practice in Colleyville, TX.

I learned from great mentors how to conduct a practice 100% by the books. This knowledge carried me through the next few years of doing relief work for dozens of chiropractic offices in NC, SC and FL while simultaneously running a house-call practice.

At what point did you realize you wanted to do something non-clinical with your background, and why?

It was by doing relief work that I not only gained immense appreciation for my first position, but realized how large of a need there is for professionals of all specialties to learn how to properly document their care.

I saw a lot of anger being wasted on not understanding the insurance process.

The thing is, if the documentation processes were followed, the doctors would find patients received better care and got better results—and the doctors themselves would have been paid more appropriately.

What are you doing these days?

In addition to running a small chiropractic practice in my home, I make care determinations and write reports for several IROs regarding appeals, personal injury, and worker’s compensation cases.

I review each patient’s individual policy, review his or her health records, and contact the providers for any additional information needed (or, at times, to discuss the policy). I then then render my opinion on the case.

Are you still treating patients, or are you solely non-clinical?

Yes, I am still treating patients. I recently relocated and opened a new office (as mentioned above), so currently it’s about 80% file review and 20% patient care.

How long have you been in your current role?

I have been specializing in peer review for about a year and a half. It took about six months before I had enough utilization review work to replace my previous income.

How did you find your job? Did you apply or find it through a connection?

I took a seminar through SEAK, and received specialized training in writing peer review.

SEAK provided me with a list of IROs to contact, and the IROs were happy to receive a resume from someone that had training from a trusted resource.

Did you do anything special to your resume and cover letter to land the job?

I followed the recommendations of the SEAK professionals for formatting my resume and cover letter.

What was the interview like for the role?

Each IRO has their own process, usually there is a Skype or Zoom interview, followed by some paperwork.

Did you get any special certifications or training along the way to help you get into your current role?

The most helpful thing was taking the SEAK seminar, where I learned how to format the reports and how to answer the questions. In addition, I have maintained multiple state licenses, which allows me to review files for most states.

When did you start your business?

I have been self-employed since 2012, so it’s been a constant evolution. Initially, I mostly did relief work and some house calls, then mostly house calls and less relief work. Then, after having my second child, I saw patients in my home and started learning about doing peer review.

Where did you get the idea for your business?

I learned about peer review in school, and it sounded interesting then, but they made it sound like it was a thing you did when you were old but still wanted to work a little.

After changing states six times in eight years, I decided that a career that was geared more towards remote work and less time/money invested into clinical practice would be beneficial.

What is your business, and what types of products or services do you offer?

Peer review and physician advisor services for independent review organizations, in addition to running a small family practice out of my home.

How have people reacted to your non-traditional career path?

I’m not sure if anyone has reacted negatively to my non-clinical work; I wouldn’t listen if they did!

What’s a typical day or week in the life like for you?

My favorite thing about non-clinical work is it allows me to work around my family’s and patients’ needs.

I have two kids in school and sports and a husband with a very demanding career that involves a lot of traveling and frequent moving.

Most days, I write my reports and do phone calls while my kids are in school. If one kid is home sick or on a school break, we can fill our day with other activities, and I will do the bulk of my report writing at night. If my husband ever gets home earlier in the week then we expected, we will go get lunch or see a movie, a luxury I never thought I could expect.

The unexpected benefit of non-clinical work is I always have the flexibility to fit in a patient whenever they need me. How many quality doctors can you call and get in with a couple hours’ notice? Not many.

My patients greatly appreciate my availability, and the knowledge I’ve gained about insurance has helped me run my practice more efficient than ever. I am never nervous about filing a set of claims, an issue that used to keep me awake at night.

What is your favorite thing about being non-clinical?

When I worked a clinic schedule of 12-hour days, I never saw my husband. We are both highly invested parents, but I still worried a lot about my kids having two “absentee” parents.

I never paid myself enough because I always wanted to pour all of my money back into my office for the newest equipment, the latest marketing guru, the best vitamins-you name it.

My husband never got to see the value my clinical practice had; even a tiny office was still a greedy monster, and I knew I was taking a large portion of myself away from my family. NOT the lifestyle I thought being a “rich doctor” was going to bring.

Non-clinical work has allowed me to use my education in a way that continued to grow, no matter how many more moves we have. It allows me to be Jessica first and doctor second, and when I am doctor, I know I’m the absolute best doctor I can be.

How do you think working as a chiropractor prepared you for this role? Which skills transferred?

My current challenge is remembering the specifics of how each company likes their reports!

There are also a few different kinds of reports to write. Some involve referencing research articles, some only the insurance policy, and then there’s the whole issue of how work comp and auto injury rules are slightly different in each state.

It’s hard to keep them all straight, but I love the challenge and each company has a great team of nurses that are always willing to help me.

Roughly speaking, how are the hours and pay compared to patient care?

The hours are amazing! I spend five to six hours working each day, but I can do the bulk of it whenever it works best for me, and it’s ok if that time changes every day. I also no longer have the overhead of an office and no longer need a housekeeper and nanny.

The pay is more efficient than clinical practice, but the thing I appreciate most is the clarity.

I have a contracted rate from each company, I deliver the report on time, they send me a check. There are no co-pays, deductibles, co-insurance, allowed amounts, non-covered services, or denials. This experience has carried over into my clinical practice and has allowed me to be exponentially more confident with insurance billing and able to take care of patients with insurance plans that most other doctors aren’t willing to accept.

What type of person do you think would do well in your role?

You do need a bit of a thick skin. Like I saw while doing relief work, many doctors waste a lot of energy in trying to debate the legitimacy of the policy instead learning how to use it.

No one is happy to get a call about a denial, but I am always able to explain why a denial has to be upheld, so I hope the doctors I call can use that information to better document their care in the future.

Remote work etiquette is not difficult but it’s specific. Companies depend on you to meet deadlines, and you have to earn trust the same way you build credit. Your reputation is extremely important. Jokes and sarcasm over email are very difficult to convey and very easy to misinterpret, so it’s important to always be professional and appreciative of the people that send you the work.

Do you work remotely or on-site?

I work from home.

Does your organization hire PT, OT, or SLP professionals into non-clinical roles?

During my SEAK seminar, I was given a list of IROs to contact, but that didn’t make it easy. I’ve had to fight very hard for every contract I have.

Most IRO’s don’t advertise openings on job boards because there’s no guarantee of any certain amount of work over a certain period of time. I am constantly emailing IROs and following up with my connections.

I probably bother the hell out of some people, but I always add my innate “Minnesota Nice” and my acquired southern hospitality to my emails, and I’d like to think I’ve brightened some people’s days at the same time as asking for work.

Did you read any books, take any courses, or do anything special overall to get you where you are today?

The SEAK Seminar for file review was the course I took, and I plan to take more seminars through them!

I maintain my own subscription to the ODG, and MD Guidelines, specifically the California ACOEM worker’s compensation policies. Maintaining multiple state licenses is a little trickier than you’d expect, but I’ve never done anything easy in life, why start now?

What is next for you? What do you want to do with your career long-term?

I hope to obtain a permanent role as an associate medical director for either an IRO or an insurance company directly.

What would you recommend to someone who is considering going into a role like yours?

Having multiple state licenses is very advantageous. A seminar specific for report writing is a must.

ALWAYS be nice. To obtain these roles, a chiropractor needs to be board certified in a specialty, which can be very time consuming and costly—and it needs to be maintained in addition to regular licensing CEUs.

What would you like to change most in your profession, and why? How would you propose doing so?

I would like to change the way professionals and patients learn about insurance policies. Currently, it’s a trial-and-error process that’s learned through years in the school of hard knocks.

Patients get mad when their insurance they pay monthly premiums for won’t cover services. Doctors get mad when they don’t get paid. If the doctor could explain the importance of open communication, and the patient understood what circumstances won’t be covered by their insurance, a lot of anger would be saved.

I think consumers need to be more responsible in learning about what their policy will cover. Insurance companies need to provide more concise resources for their customers to learn about their policy.

Professionals need to learn the consequences of improper documentation. There is a plethora of free webinars, ebooks, and newsletters offered by many insurance conglomerates that help doctors or their insurance employees learn how to document their care better. If more of these resources were utilized, the doctor would have more time to give better quality care to more patients and would make more money doing it.

When I discuss policies with doctors, a common comment I get is, “So you’re telling me I need to lie in my records so the patient can meet the confines of the policy?”

No. N.O.

What I’m saying is that we, as professionals, need to share with the patient what insurance covers and doesn’t cover, so that they understand if they are coming in 1x/month with a 1 of 10 pain it’s important for them to pay cash so everyone’s premiums can be low—plus, it saves coverage for times that they actually need to come in 3x/week for multiple therapies.

Or, if they are managing an injury, insurance isn’t going to cover them getting to 100% perfect function, it’s going to cover them getting them to the point where they can then take care of themselves. Once a clinical plateau or maximum medical improvement (MMI) is met, there is no more coverage. This, again, helps keep premiums low.

If you could teach anything to today’s graduate students in your profession, what would it be?

Being a good person that wants to help people is not enough. You can’t help people if your office is bankrupt.

You need to learn what different types of insurance will cover and how to explain that to patients so no one is surprised. If you are efficient at this, you will never need to outgrow your capacity for compassion and quality care.