PHYSICIAN ADVISOR (FT; REMOTE) - Temple University Hospital

Temple University Health System; Philadelphia (Philadelphia County); Remote; USD 180,000 - 240,000; Full time

Job summary

Temple University Hospital is seeking a Physician Advisor (FT; Remote) to provide clinical expertise to the Clinical Analysis and appeals team and to serve as the physician advisor for medical necessity appeals and PAMA utilization reviews. The role requires a Doctorate in Medicine or Osteopathic Medicine, strong Interqual criteria knowledge, and experience with managed care appeals.

It includes acting as a resource for regulatory and revenue cycle denial and appeals processes in a hospital

Qualifications

• Doctorate in Medicine or Osteopathic Medicine required.
• Strong working knowledge of the Interqual Criteria Set.
• Experience with second/third level appeals and expert witness roles in a managed care environment.

Responsibilities

• Provide clinical expertise and guidance to the Clinical Analysis and appeals team.
• Act as the physician advisor for medical necessity appeals and for PAMA utilization reviews.
• Serve as physician resource for regulatory and revenue cycle denial/appeals processes for hospital activity.

Skills

Interqual criteria

Appeals expertise

Regulatory knowledge

Managed care experience

Education

Doctorate Degree in Medicine or Osteopathic Medicine

Job description

PHYSICIAN ADVISOR (FT; REMOTE) - Temple University Hospital (263462)

Provides clinical expertise and guidance to Clinical Analysis and appeals team. Acts as the physician advisor for medical necessity appeals and for the Pennsylvania Medical assistance (PAMA) utilization reviews. Acts as a physician resource for the regulatory and revenue cycle denial and appeals processes for hospital activity, including utilization review for all PAMA cases, all UM denials and appeals.

Education

Doctorate Degree Medicine or Osteopathic Medicine Required

Experience

• General Experience and strong working knowledge of the Interqual Criteria Set and hospital reimbursement systems Required
• General Experience in a role dealing with Second and Third level appeals processes including direct experience with being an expert witness Required
• General Experience in a managed care environment Required
• General Experience in an Administrative Leadership role Preferred

Licenses

• PA Medical Physician License Required or
• PA Osteopathic Physician Required

Your Tomorrow is Here!

Temple Health is a dynamic network of outstanding hospitals, specialty centers, and physician practices that is advancing the fight against disease, pushing the boundaries of medical science, and educating future healthcare professionals. Temple Health consists of Temple University Hospital (TUH), Fox Chase Cancer Center, TUH-Jeanes Campus, TUH-Episcopal Campus, TUH-Northeastern Campus, Temple Physicians, Inc., and Temple Transport Team. Temple Health is proudly affiliated with the Lewis Katz School of Medicine at Temple University.

To support this mission, Temple Health is continuously recruiting top talent to join its diverse, 10,000 strong workforce that fosters a healthy, safe and productive environment for its patients, visitors, students and colleagues alike. At Temple Health, your tomorrow is here!

Equal Opportunity Employer/Veterans/Disabled

An Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

Your Tomorrow is Here!

Temple University Hospital is a nationally respected teaching hospital on Temple University's bustling Health Sciences Center campus.The hospital provides a comprehensive array of healthcare services both basic and complex to patients from around the corner, across the country and around the world. As the chief clinical training site for the Lewis Katz School of Medicine at Temple University, the hospital provides a dynamic environment for high-quality care, teaching, and cutting edge research.