Physician Advisor - part time

Temple University; Philadelphia (Philadelphia County); On-site; USD 269,000 - 426,000; Part time

Job summary

Temple University is seeking a part-time Physician Advisor to provide clinical expertise and guidance for medical necessity appeals. The role requires strong analytical skills and relevant experience in managed care environments. Successful candidates will hold a Doctorate in Medicine or Osteopathic Medicine, possess a PA medical license, and have experience in appeals processes.

Qualifications

• General Experience in appeals processes including as an expert witness.
• Experience in a Managed Care Environment.
• Experience in Administrative Leadership roles preferred.

Responsibilities

• Provides clinical expertise and guidance to clinical analysis and appeals team.
• Acts as the physician advisor for medical necessity appeals.
• Supports regulatory and revenue cycle denial and appeals processes.

Skills

Knowledge of Interqual Criteria Set

Strong analytical skills

Expertise in appeals processes

Education

Doctorate Degree in Medicine or Osteopathic Medicine

Job description

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Join to apply for the Physician Advisor - part time role at Temple University

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)

License/Certifications

MD-LIC - PA Medical Physician License (Required) or DO-LIC - 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.

Required

Preferred

Job Industries

• Other

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Part-time

Job function

• Job function

  Health Care Provider

• Industries

  Higher Education

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