Payer Peer to Peer Physician Advisor

R1 RCM, Inc.; United States; Remote; USD 150,000 - 199,000; Full time

Job summary

R1 RCM Inc. is seeking a Physician Advisor to help client facilities navigate compliant revenue through payor peer-to-peer case reviews and documentation evaluation.

You will assess authorization requests, verify admission status, procedure and care setting documentation, and discuss cases with payor medical directors. Requirements include active, unrestricted MD or DO licensure and 3+ years of clinical experience post-residency; this is a remote US-based role with a $150k–$199k base, plus a 10%

Qualifications

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

Responsibilities

• Addresses authorization issues and documentation support or lack of support for that authorization.
• Review and respond to the payor and customer in a timely manner.
• 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.

Skills

MD or DO licensure

3+ years clinical experience

Education

MD or DO degree

Job description

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

R1 RCM Inc. ("the Company")