Physician Advisor: Appeals & Utilization Review

Temple Health – Temple University Health System; Philadelphia (Philadelphia County); In loco; USD 190.000 - 270.000; Tempo pieno

Descrizione del lavoro

Temple Health – Temple University Health System in Philadelphia, PA, is seeking a physician advisor for medical necessity appeals. The role provides clinical expertise to the Clinical Analysis and appeals team, supports PAMA utilization reviews, and serves as a physician resource for regulatory and revenue cycle denial/appeals across hospital activity.

The position is full-time, 40 hours per week, with a day shift schedule.

Competenze

• Experience with Interqual Criteria Set and hospital reimbursement systems.
• Experience in second and third level appeals processes.
• Direct experience as an expert witness is required.
• Experience in a managed care environment.
• Administrative leadership experience preferred.

Mansioni

• Provide physician advisor for medical necessity appeals and PAMA utilization reviews.
• Guide clinical analysis and appeals team.
• Serve as physician resource for regulatory and revenue cycle denial and appeals across hospital activity.

Conoscenze

Interqual knowledge

Reimbursement systems

Appeals expertise

Expert witness

Managed care

Descrizione del lavoro

Temple Health – Temple University Health System in Philadelphia, PA, is seeking a physician advisor for medical necessity appeals. The role provides clinical expertise to the Clinical Analysis and appeals team, supports PAMA utilization reviews, and serves as a physician resource for regulatory and revenue cycle denial/appeals across hospital activity.

The position is full-time, 40 hours per week, with a day shift schedule.