Payer Peer to Peer Physician Advisor

R1 RCM, Inc.; Florida; Hybrid; USD 150,000 - 199,000; Full time

Benefits offered by this job

Annual bonus plan

Job summary

R1 RCM Inc. is seeking a Physician Advisor for a remote US-based role to guide compliant revenue by reviewing payor peer-to-peer denial cases and advising on documentation adequacy for admissions, procedures, and care settings. The role requires MD/DO licensure and substantial clinical experience.

You will discuss cases with payor medical directors, provide written analyses, and serve as a clinical resource to ensure appropriate utilization decisions in a fast-paced environment.

Qualifications

• Active, unrestricted MD or DO medical licensure.
• Minimum 3+ years of clinical experience post-residency.

Responsibilities

• Review payor peer-to-peer cases denied authorization, evaluating documentation for admission status, procedure, and care setting.
• Advise on the appropriateness of the authorization based on available documentation and discuss cases with payor medical directors.
• Provide written analysis of cases and perform reviews across multiple specialties.
• Serve as a clinical resource to medical and case management staff by identifying, facilitating, and resolving documentation and utilization issues.
• Respond to payor and customer in a timely manner.

Skills

MD/DO licensure

Clinical experience 3+ years

Education

MD or DO (allopathic/osteopathic)

Job description

Remote, USA

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Full time

R260000004845

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

As our Physician Advisor , you will help our client facilities navigate the path to compliant revenue by reviewing payor peer-to-peer cases. Every day. You will review cases for which authorization has been denied, evaluating if the proper documentation was available for the admission status, procedure, and care setting that was requested. You will also advise our clients regarding the appropriateness of the request based on available documentation, as well as discuss the cases with medical directors from the payor side.

To thrive in this role, you must have strong clinical knowledge across multiple clinical areas and be capable of working independently with a high level of performance in a rapidly changing, fast-paced environment. Proficiency in basic computer skills is essential for excelling in this remote position.

Here’s what you will experience working as a Physician Advisor:

• Addresses the following issues: authorization requested, documentation support or lack of support for that authorization, evidence-based criteria for that support, and complex clinical evaluation of the request as a whole.

• Review and respond to the payor and customer in a timely manner.

• Actively engage with payor medical directors to discuss appropriate authorization status as supported by documentation.

• Provide written analysis of the case and perform case reviews across multiple specialties.

• Serve as a clinical resource to medical and case management staff by providing identification, facilitation, and resolution of documentation and utilization issues.

Required Skills:

• Active, unrestricted MD or DO medical licensure

• Minimum 3+ years of clinical experience post-residency completion

For this US-based position, the base pay range is $150,075.00 - $199,070.29 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

This job is eligible to participate in our annual bonus plan at a target of 10.00%

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package. (http://go.r1rcm.com/benefits)

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent (https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf)

To learn more, visit: R1RCM.com

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R1 is the leader in healthcare revenue management, helping providers achieve new levels of performance through smart orchestration. A pioneer in the industry, R1 created the first Healthcare Revenue Operating System: a modular, intelligent platform that integrates automation, AI, and human expertise to strengthen the entire revenue cycle. With more than 20 years of experience, R1 partners with 1,000 providers, including 95 of the top 100 U.S. health systems, and handles over 270 million payer transactions annually. This scale provides unmatched operational insight to help healthcare organizations unlock greater long-term value. To learn more, visit: https://www.r1rcm.com .