PHYSICIAN ADVISOR - PA LICENSE REQUIRED (FT; REMOTE) - Temple University Hospital

Temple Health – Temple University Health System; Philadelphia (Philadelphia County); On-site; USD 190,000 - 270,000; Full time

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Interqual knowledge

Reimbursement systems

Appeals expertise

Expert witness

Managed care

Job description

Category: Physicians

Job Location: 3401 North Broad Street, Philadelphia, Pennsylvania, United States

Weekly Hours: 40.00

Schedule: Full-Time

Shift Day Shift 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.

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