Peer to Peer Physician Advisor - Revenue Cycle

Hawaii Pacific Health; Honolulu (HI); Sur place; USD 165 000 - 207 000; Plein temps

Résumé du poste

Hawaii Pacific Health is seeking a Peer to Peer Physician Advisor to provide consultative leadership across utilization management, medical necessity determinations, denial prevention, and revenue cycle performance. This role collaborates with medical staff, case management, CDI, and health plan medical directors to facilitate proper patient status and level-of-care decisions.

Responsibilities include conducting peer-to-peer discussions with health plan directors, educating physicians, ensuring

Qualifications

• MD/DO physician with license to practice in Hawai‘i and current board certification.
• Five (5) years of direct clinical patient care experience.
• Experience with utilization management, medical necessity reviews, and payer interactions.

Responsabilités

• Lead utilization management and medical necessity reviews; support denial prevention and denial management.
• Serve as liaison between medical staff, case management, CDI, revenue cycle leadership and health plan medical directors to determine patient status and level of care.
• Conduct peer-to-peer discussions with health plan medical directors and provide physician education.
• Support regulatory compliance and promote best practices in documentation integrity and utilization management.

Formation

Doctorate Degree in Medicine (MD or DO)

Outils

DEA certification

Description du poste

Hawai'i Pacific Health is a not-for-profit health care network with over 70 locations statewide including medical centers, clinics, physicians and other caregivers serving Hawai'i and the Pacific Region with high quality, compassionate care. Its four medical centers - Kapi'olani, Pali Momi, Straub and Wilcox - specialize in innovative programs in women’s health, pediatric care, cardiovascular services, cancer care, bone and joint services and more. Hawai'i Pacific Health is recognized nationally for its excellence in patient care and the use of electronic health records to improve quality and patient safety.

The Revenue Cycle department monitors revenue cycle management for all Hawai‘i Pacific Health hospitals, clinics and other entities. It achieves this through Revenue Cycle Task Force committees and processes for Hospital, Physician, Pharmacy, Pacific Islanders, Worker compensation, and direct oversight and management of the Billing, Charge Description Management, Coding, Admissions and Financial Service functions. Revenue Cycle staff monitor inpatient and outpatient charge posting, billing, and collection operation, while recommending and implementing policies and procedures to ensure departmental effectiveness and compliance with insurance billing regulations, government billing requirements, collection laws and reimbursement procedures.

As the Peer to Peer Physician Advisor, you will provide consultative leadership and physician expertise to support utilization management, medical necessity determinations, denial prevention, denial management, and revenue cycle performance across Hawai‘i Pacific Health. In this role, you will serve as a liaison between medical staff, case management, clinical documentation integrity (CDI), revenue cycle leadership, and health plan medical directors to facilitate appropriate patient status determinations, level-of-care decisions, and successful resolution of payer clinical denials and utilization concerns. Other responsibilities include conducting peer-to-peer discussions with health plan medical directors, providing physician education, supporting regulatory compliance, and promoting best practices in utilization management and documentation integrity.

Location: First Insurance Center

Work Schedule: Rotating - 8 Hours

Work Type: Per Diem

FTE: 0.475000

Bargaining Unit: Non-Bargaining

Exempt: Yes

Pay Range: 120.00 - 150.00 USD per hour

Category: Physician

Minimum Qualifications: Doctorate Degree in Medicine (MD or DO). Current Board Certification and license to practice as a Physician in Hawai‘i. Current medical staff membership and clinical privileges in good standing within Hawai‘i Pacific Health. Current and valid DEA certification, where applicable. Valid driver’s license, abstract, and current Hawai‘i auto insurance. Five (5) years of direct clinical patient care experience. Experience with utilization management, medical necessity reviews, case management, physician documentation improvement, or payer interactions. Experience conducting physician-level discussions regarding patient status or level-of-care determinations.

Preferred Qualifications: Certification or advanced training in Physician Advisory Services, Utilization Management, Clinical Documentation Integrity, or Healthcare Quality. Board certification maintained throughout employment. Previous Physician Advisor experience. Experience with payer denials management and appeals. Experience leading multidisciplinary performance improvement initiatives. Demonstrated experience educating physicians regarding documentation, utilization review, and medical necessity requirements.

EOE/AA/Disabled/Vets

Hawai‘i Pacific Health offers a comprehensive and competitive total rewards package that includes pay and benefits. Rate of pay for selected candidates will be determined by various factors including knowledge, skills, abilities, relevant experience and training, as well as internal peer equity.