Payer Peer to Peer Physician Advisor

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

Benefits offered by this job

Annual bonus plan

Job summary

R1 is seeking a Physician Advisor to review payor denial cases, evaluating documentation for admission status, procedure, and care setting. You will discuss cases with payor medical directors and provide written analysis across multiple specialties.

The role requires an active MD/DO license in the US and at least 3 years of post-residency clinical experience. This is a remote position with a target annual bonus of 10% and base pay disclosed.

Qualifications

• Active, unrestricted MD or DO medical licensure.
• Minimum 3+ years of clinical experience post-residency.
• US-based role with base pay range disclosed.

Responsibilities

• Review payor peer-to-peer cases for authorization status.
• Assess documentation for admission status, procedure, and care setting.
• Discuss cases with payor medical directors to determine authorization.
• Provide written analysis and case reviews across multiple specialties.
• Serve as a clinical resource to staff addressing documentation and utilization issues.

Skills

MD/DO licensure

Clinical experience

Education

MD/DO degree

Job description

Company Overview

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.

Physician Advisor Role

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.

Responsibilities

• 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 and Compensation

• 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%

Career Growth and Benefits

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.

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.

Disability Accommodation

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.

About R1

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.