Physician Advisor

2 days ago Be among the first 25 applicantsOverview:The On-Site Physician Advisor (OSPA) conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing appeal letters) in support of the centralized system Utilization Review (UR) process for Sentara hospital facilities. The Physician Advisor serves an important role in ensuring compliant hospital status/billing for hospital patients and strengthening relationships between Clinical Revenue Cycle, UR, hospital leadership, medical staff, and hospital ICM. The Physician Advisor interfaces directly with the medical staff, providing concurrent communication and education to attending physicians (and their APCs) regarding recommended changes in hospital status, pertinent regulatory requirements and guidance impacting the determination, as well as documentation integrity to support medical necessity of services being delivered.City/StateNorfolk, VAWork ShiftFirst (Days)Overview:The On-Site Physician Advisor (OSPA) conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing appeal letters) in support of the centralized system Utilization Review (UR) process for Sentara hospital facilities. The Physician Advisor serves an important role in ensuring compliant hospital status/billing for hospital patients and strengthening relationships between Clinical Revenue Cycle, UR, hospital leadership, medical staff, and hospital ICM. The Physician Advisor interfaces directly with the medical staff, providing concurrent communication and education to attending physicians (and their APCs) regarding recommended changes in hospital status, pertinent regulatory requirements and guidance impacting the determination, as well as documentation integrity to support medical necessity of services being delivered.As this role’s duties include significant interpersonal and relational aspects in addition to regulatory training and licensing requirements, an active and unrestricted Virginia medical license and board-certified status at the time of hire are required, as well as superb interpersonal and communication skills. Due to the collaborative and highly relational nature of this role, on-site (in person) presence is integral. Coverage at additional sites may be required, including occasional in-person responsibilities. The position reports to the Director of Regional Physician Advisors to Clinical Revenue Cycle.Perform timely and compliant medical necessity reviews, providing clear documentation of the pertinent details of the case to satisfy regulatory requirements and directly communicating any necessaryFacilitate denials management through review of selected cases, conducting peer to peer discussion with third party payers as appropriate, and assisting with appeals lettersWork closely with hospital leadership, medical staff, and hospital ICM leaders to support system CPIs and initiativesAttend and participate in Hospital UM committees at designated sitesComplete training and continuing education as deemed necessaryAttend and participate in educational presentations to medical staff, administration, leadership and peersAdditional functions as deemed appropriate and warrantedMinimum Requirements:Completion of Medical doctorate or Doctor of Osteopathy degree from an accredited medical schoolCompletion of an accredited residency training programMinimum of 3 years of clinical experience, hospital clinical experience strongly preferredActive and unrestricted state Virginia medical licenseBoard certification in specialty required at time of hirePossess or acquire a working knowledge of CMS regulatory guidance and requirements as they pertain to UR and site of service decisionsPossess a working knowledge of clinical documentation integrity, hospital billing and coding processes and guidelines, case mix index, and DRG assignmentsFamiliarity with standard published leveling criteria such as MCG/Interqual and ability to apply professional judgment and patient specific variables as may be necessary or justifiableFamiliarity with (Hospital) organization and case management operationsExcellent customer service and interpersonal skills.Able to effectively present information, both formal and informalSuperb written and verbal communications skillsAbility to set and manage prioritiesDemonstrate flexibility, teamwork, and a collaborative leadership styleStrong technical/computer skills and working knowledge of the system’s EMRBenefits: Caring For Your Family and Your CareerMedical, Dental, Vision plansAdoption, Fertility and Surrogacy Reimbursement up to $10,000Paid Time Off and Sick LeavePaid Parental & Family Caregiver LeaveEmergency Backup CareLong-Term, Short-Term Disability, and Critical Illness plansLife Insurance401k/403B with Employer MatchTuition Assistance – $5,250/year and discounted educational opportunities through Guild EducationStudent Debt Pay Down – $10,000Reimbursement for certifications and free access to complete CEUs and professional developmentPet InsuranceLegal Resources PlanColleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.In support of our mission “to improve health every day,” this is a tobacco-free environment.For positions that are available as remote work, Sentara Health employs associates in the following states:Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.Seniority levelSeniority levelNot ApplicableEmployment typeEmployment typeFull-timeJob functionJob functionHealth Care ProviderIndustriesHospitals and Health CareReferrals increase your chances of interviewing at Sentara Health by 2xNorthampton, England, United Kingdom 1 week agoLutterworth, England, United Kingdom 1 month agoNorthampton, England, United Kingdom 1 week agoSt Neots, England, United Kingdom 5 days agoNorthampton, England, United Kingdom 4 days agoMilton Keynes, England, United Kingdom 5 days agoEngland, United Kingdom $27,500 - $30,000 2 weeks agoMilton Keynes, England, United Kingdom 1 week agoMilton Keynes, England, United Kingdom 5 days agoWe’re unlocking community knowledge in a new way. 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