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Physician Advisor Job
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Cleveland, Ohio |
About this job
- MD / DO
Physician Advisor
Collaborates with medical staff and case management to educate and optimize the use of hospital services and validates that patients are in the appropriate level of care. Works with commercial and government auditors and the medical directors at the insurance plans to appeal denials. Communicates with the payers as requested to resolve any disputes surrounding medical necessity denials. Participates in level of care determinations on a case-by-case basis. Collaborates with medical staff and hospital departments. Creates and/or authorizes all appeal letters via signature. Researches and utilizes external tools and data to support appeal letters. Provides consultation to Finance Case Managers regarding complex clinical issues and advises on next steps. Conducts Physician education sessions to share data, trends, practice patterns and other relevant information as requested. Knowledge of current medical literature, research methodology, healthcare delivery systems, healthcare financial reimbursement issues and medical staff organizations.
EDUCATION: Medical Doctor degree.
LICENSURE/CERTIFICATION/REGISTRATION: Medical Doctor licensure is preferred.
COMPLEXITY OF WORK: REQUIRED EXPERIENCE: Background or actual involvement in health service delivery research or decision analysis preferred. PHYSICAL REQUIREMENTS: Manual dexterity to operate office equipment. Requires extended periods of standing, walking, sitting and carrying up to 25 pounds. Normal or corrected vision and hearing to normal range. PERSONAL PROTECTIVE EQUIPMENT: Follows Standard Precautions using personal protective equipment as required for procedures. MEDICAL STAFF APPROVAL:
Job Segments:
Healthcare , Non-Clinical , Managerial/Professional/Physician-j2w , MPNC , Medical , Research , Physician
Physician Advisor
Collaborates with medical staff and case management to educate and optimize the use of hospital services and validates that patients are in the appropriate level of care. Works with commercial and government auditors and the medical directors at the insurance plans to appeal denials. Communicates with the payers as requested to resolve any disputes surrounding medical necessity denials. Participates in level of care determinations on a case-by-case basis. Collaborates with medical staff and hospital departments. Creates and/or authorizes all appeal letters via signature. Researches and utilizes external tools and data to support appeal letters. Provides consultation to Finance Case Managers regarding complex clinical issues and advises on next steps. Conducts Physician education sessions to share data, trends, practice patterns and other relevant information as requested. Knowledge of current medical literature, research methodology, healthcare delivery systems, healthcare financial reimbursement issues and medical staff organizations.
EDUCATION: Medical Doctor degree.
LICENSURE/CERTIFICATION/REGISTRATION: Medical Doctor licensure is preferred.
COMPLEXITY OF WORK: REQUIRED EXPERIENCE: Background or actual involvement in health service delivery research or decision analysis preferred. PHYSICAL REQUIREMENTS: Manual dexterity to operate office equipment. Requires extended periods of standing, walking, sitting and carrying up to 25 pounds. Normal or corrected vision and hearing to normal range. PERSONAL PROTECTIVE EQUIPMENT: Follows Standard Precautions using personal protective equipment as required for procedures. MEDICAL STAFF APPROVAL:
Job Segments:
Healthcare , Non-Clinical , Managerial/Professional/Physician-j2w , MPNC , Medical , Research , Physician
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