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Physician Advisor I - Psychiatry - Full-Time and Per Diem Opportunities Available
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | NEWTOWN SQUARE, PA NEWTOWN SQUARE, Pennsylvania |
About this job
Basic Function
The Physician Advisor represents contracted hospitals in matters involving concurrent denials. These services are performed telephonically with medical directors who have denied inpatient stays.
In addition, the Physician Advisor in Commercial Appeals serves as an advocate and an appeal expert for the hospitals by conducting thorough reviews of the hospital medical records for claims denied by the commercial payers, summarizing the services provided during the hospital stay, and providing appeal arguments based on clinical judgment and evidence based medicine. With EHR's proprietary technology, the Physician Advisor in Commercial Appeals will have access to-up-to-date medical and evidence based literature and will serve as a resource to our hospital clients to ensure the quality of documentation.
Job Responsibilities
- Conducts the review of cases submitted by clients for peer-to-peer review and/or written appeal. Prepares and provides appeal arguments for inappropriately denied or downgraded medical necessity determinations made by health care organizations.
- Represents clients in peer-to-peer review with commercial payers, prepares memoranda, and presents cases.
- Serves as an expert witness, when appropriate, during the appeal of selected cases to the Administrative Law Judges of the Office of Medicare Hearings and Appeals and State Medicaid.
- Documents clearly and concisely all interactions, interventions and outcomes of physician advisory work performed in EHRic and follows all EHR policies and procedures.
- Promotes payer and client adherence to all applicable accreditation standards and federal and state regulatory guidelines.
- Performs other related duties as required.
Requirements
Hours
- Day hours Monday through Friday, remote or onsite evening and weekend hours based on team assignment and/or team need.
- Required On-site Training in Malvern, PA week 1, Mon-Fri 8a-5p
- Telecomute/Remote work available post-training
Skills
- Ability to handle all psychiatric cases, including complex cases
- Good general medical knowledge and ability to handle general medical cases
- Ability to review medical records and extract pertinent facts
- Strong negotiation skills
- Understands all company processes/policies, key regulations, and clinical content
- Participates in meetings with team
- Produces complete and thorough documentation
- Requires limited QA
- Ability to learn new concepts and payer processes
- Strong, effective verbal and written communication skills
- Outstanding analytical skills
- Computer proficient, with strong typing skills
- Positive attitude and the ability to function as a collaborative team member
- Ability to communicate effectively with colleagues of all levels
- Adherence to HIPAA confidentiality requirements
- Ability to follow specialized appeals processes as defined by commercial payers
- Good problem solver
- Team Player
- Strong Clinical knowledge base
- Organized
- Professional
Education/Experience
- MD or DO licensure required; Board Certification preferred
- 3+ years of post-residency, inpatient care experience preferred
Careers with Optum. We built an entire organization around one giant objective; make the health system work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on an elite team. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Certain positions are subject to random drug testing.
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